Rationale for seeking occult metastases in patients with bronchial carcinoma

The usefulness of performing diagnostic staging tests on patients thought to have operable bronchial carcinoma was explored by modeling the diagnostic and therapeutic processes for patients with this disease. The availability of appropriate autopsy and survival data allowed this investigation. We analyzed the results of two diagnostic and therapeeutic strategies: a test strategy in which extensive staging tests are performed preoperatively on patients with Stage I or II disease and a no test strategy in which such examinations are not performed. Average survival times are little affected by the choice of the test or no test diagnostic strategy. The chance of an immediate postoperative death, of an unnecessary operation and of a long term cure are affected more. Within the error of measurement, financial costs for the two strategies are probably the same. This investigation is a prototype for estimating the value of diagnostic staging tests and the effects of consequent alternative methods of treatment for patients with known malignant conditions.