Optimal sequence of tests for the mediastinal staging of non-small cell lung cancer

BMC Medical Informatics and Decision Making
Manuel LuqueCarlos Disdier

Abstract

Non-small cell lung cancer (NSCLC) is the most prevalent type of lung cancer and the most difficult to predict. When there are no distant metastases, the optimal therapy depends mainly on whether there are malignant lymph nodes in the mediastinum. Given the vigorous debate among specialists about which tests should be used, our goal was to determine the optimal sequence of tests for each patient. We have built an influence diagram (ID) that represents the possible tests, their costs, and their outcomes. This model is equivalent to a decision tree containing millions of branches. In the first evaluation, we only took into account the clinical outcomes (effectiveness). In the second, we used a willingness-to-pay of € 30,000 per quality adjusted life year (QALY) to convert economic costs into effectiveness. We assigned a second-order probability distribution to each parameter in order to conduct several types of sensitivity analysis. Two strategies were obtained using two different criteria. When considering only effectiveness, a positive computed tomography (CT) scan must be followed by a transbronchial needle aspiration (TBNA), an endobronchial ultrasound (EBUS), and an endoscopic ultrasound (EUS). When the CT scan is negative, ...Continue Reading

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Citations

Mar 13, 2015·Methods of Information in Medicine·M Arias, F J Díez
Feb 23, 2018·Experimental and Therapeutic Medicine·Junjian Wang, Shaoxiang Huang
Jun 8, 2018·Journal of Evidence-based Medicine·Beatriz Nistal-Nuño
Jan 16, 2021·The Clinical Respiratory Journal·José Antonio GullónJosé M García-García
May 6, 2021·Current Oncology·Christopher J L StoneGeneviève C Digby
Jun 16, 2021·Artificial Intelligence in Medicine·Francisco Javier DíezJorge Pérez-Martín

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Methods Mentioned

BETA
surgical resection
imaging techniques

Software Mentioned

Net
OpenMarkov
QALE
Elvira
MEDIASTINET

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