Mediastinal staging in non-small-cell lung cancer.

Decision analysis was used to study the approach to staging mediastinal involvement in patients with non-small-cell lung cancer (NSCLC). Various diagnostic strategies for mediastinal disease staging using computed tomography (CT), mediastinoscopy, and bronchoscopy with transbronchial needle aspiration (TBNA), either individually or in series, were compared and found to result in similar patient life expectancies. Two strategies, one using bronchoscopy and TBNA alone and the other using it in combination with CT, were consistently least expensive across a wide range of prior probabilities, test characteristics, and charges. The authors conclude that strategies for staging mediastinal involvement in NSCLC that rely on bronchoscopy and TBNA are preferable because they are least expensive.