[Cost-benefit analysis of thoracic computerized tomography as exemplified in the N-staging of bronchial carcinoma].

In 60 selected patients affected by a limited stage of bronchial carcinoma according to clinical examinations, routine computed tomography and mediastinoscopy were performed to detect metastatic lymph-node involvement. Patients with histologically proven mediastinal lymph-node metastasis (stage N 2-3) subsequently were excluded from surgical therapy. As alternative diagnostic procedures four different strategies are discussed to estimate the greatest efficacy regarding costs and benefits in preoperative staging of malignant lung tumors: (1) primary thoracotomy, (2) routine mediastinoscopy, (3) thoracic CT-scanning and (4) CT-scanning combined with selective mediastinoscopy. Efficacy was then evaluated by the criteria of financial expenditure for each curative resection. As a result there are but small differences between the four diagnostic approaches and thoracic CT-scanning definitely does not reduce the overall costs of curative surgery or markedly improve the diagnostic yield. However, the combination of selected mediastinoscopy with CT-scanning at least increased comfort and safety in preoperative staging of patients without loss of sensitivity or specificity in detecting resectable tumors. This method should therefore be favoured for evaluating the resectability of bronchial carcinoma.