Các tác giả tính toán chi phí để phát hiện di căn 9, 20 hoặc 36 lần cao hơn khi X quang ngực, siêu âm bụng hoặc cả hai đã được sử dụng, so với kiểm tra lâm sàng thường xuyên. Weiss et al. [3] điều tra làm thế nào tái phát được chẩn đoán ở 145 bệnh nhân được điều trị trong một nghiên cứu lâm sàng | 140 CHAPTER 11 mended. The authors calculated that the cost to detect one metastasis was 9 20 or 36 times higher when chest radiograph abdominal ultrasound or both were used as compared to regular clinical examination. Weiss et al. 3 investigated how recurrence was diagnosed in 145 patients treated in a clinical study. In 99 patients 68 symptoms signalled the recurrence of disease and physical examination of asymptomatic patients led to the detection of recurrence in 37 patients 26 . Only nine patients 6 with recurrent disease had abnormal chest radiographs. A retrospective analysis of 1004 patients with stage I or II malignant melanoma treated at Roswell Park Cancer Institute between 1971 and 1995 analysed impact of method of recurrence detection on survival 5 . Of note in this series only 7 of patients had AJCC pT4 tumours. Constitutional symptoms heralded 17 of 154 recurrences physical examination 72 over half patients detected and chest radiograph 11 17 patients . Overall survival curves were superimposable for patients who detected their recurrence themselves and those whose recurrence was detected by the physician. Survival was identical in patients whose pulmonary recurrence was picked up by chest radiograph or by symptoms. However nine of the 17 patients with recurrences detected by chest radiograph alone underwent curative surgical excision with median survival of 24 months from diagnosis of recurrence compared to 15 months in patients who received chemotherapy for unresectable disease. We estimate that for the 1004 patients followed up according to protocol for a median of years with 174 recurring at a median of years and 830 patients not recurring during reported follow-up over 10 000 chest radiograph investigations would have been performed to detect the 17 recurrences. Although the patient dose from a single chest radiograph is minimal the cumulative dosage over the study period for say 10 radiographs is not. Unfortunately no information was .
