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The models differ with respect to how the effectiveness of screening is modeled: in the Sonnenberg et al. model, benefit of screening is an explicit model parameter of 18% for early detection and 75% for adenoma removal; in the Khandker et al. model, the screening benefit is the result of the improved stage distribution with screening and prevention of colorectal cancer with removal of adenomas.
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Aside from the initial stage-of-change improvement observed in the intervention group in both settings, the observed outcomes did not follow what was expected according to the conceptual model of improved stage-of-change, self-efficacy, and knowledge leading to behavior change and improved clinical outcomes.
Improved staging with the use of imaging might help in avoiding unnecessary surgical interventions, which increases the morbidity of disease without a substantial benefit in the reduction of mortality.
This process of improved stage-specific survival has been described previously at the occasion of a previous revision of the lung cancer TNM [52].
It has been shown in several series that the introduction of both techniques has significantly improved the accuracy of clinical staging and upstaged the stage distribution at diagnosis, hence changing treatment algorithms and improved stage-specific outcomes [51].
Whether these ramifications of improved staging result in a survival benefit is unknown.
The integration of PET and CT in PET/CT provides accurate anatomic localisation and improved staging over PET alone.
28 Thus, these results are consistent with the theory of maintained or improved staging accuracy with use of TcTM.
Despite improved staging with more extensive lymphadenectomy and better locoregional control, the true impact on survival is still controversial, in part due to the effect of stage migration and distant disease relapse.
Improved staging, better local disease control and improved disease-free survival from more extensive surgery must be set against longer operation times, increased morbidity and no proven overall survival benefit.
Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, as well as improved staging and guidance of therapeutic procedures.
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CEO of Professional Science Editing for Scientists @ prosciediting.com