Hadzijahic N, Wallace M B, Hawes R H, VanVelse A, LeVeen M, Marsi V, Hoffman B J, Sahai A V
Division of Gastroenterology and Hepatology/Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Gastrointest Endosc. 2000 Dec;52(6):715-20. doi: 10.1067/mge.2000.108481.
Patients with advanced (T4 and/or M1) esophageal cancer are offered palliative therapy. Computed tomography (CT) is sensitive for distant metastases but is less sensitive than endosonography for T4 disease and celiac lymphadenopathy. The aim of this study was to determine whether initial CT or endosonography costs less to diagnose advanced esophageal cancer.
A decision model compared the costs of the 2 strategies. Sensitivity analysis and threshold analysis were used to identify the most important determinants of the overall cost of identifying advanced disease.
Initial CT is the least costly strategy if the probability of finding advanced disease by initial CT is greater than 20%, if the probability of finding advanced disease by initial endoscopic ultrasound (EUS) is less than 30%, or if the cost of EUS is greater than 3.5 times the cost of CT. However, in our referral center population, endosonography found advanced disease more frequently than CT (44% vs. 13%; p < 0.0001) and the least costly strategy was initial endosonography (expected cost $804 vs. $844).
CT remains as the initial staging test of choice in most clinical settings. However, in referral centers, initial EUS may be reasonable, but individualized model inputs must be obtained before reliable conclusions can be drawn.
晚期（T4和/或M1）食管癌患者接受姑息治疗。计算机断层扫描（CT）对远处转移敏感，但对T4期疾病和腹腔淋巴结病的敏感性低于内镜超声检查。本研究的目的是确定初始CT或内镜超声检查诊断晚期食管癌的成本是否更低。
采用决策模型比较两种策略的成本。敏感性分析和阈值分析用于确定识别晚期疾病总成本的最重要决定因素。
如果初始CT发现晚期疾病的概率大于20%，初始内镜超声（EUS）发现晚期疾病的概率小于30%，或者EUS的成本大于CT成本的3.5倍，则初始CT是成本最低的策略。然而，在我们的转诊中心人群中，内镜超声检查比CT更频繁地发现晚期疾病（44%对13%；p<0.0001），成本最低的策略是初始内镜超声检查（预期成本804美元对844美元）。
在大多数临床环境中，CT仍然是首选的初始分期检查。然而，在转诊中心，初始EUS可能是合理的，但在得出可靠结论之前，必须获得个体化的模型输入。
