IN THIS ISSUE of the ARCHIVES, Schapira and Jarrett1 critically examine the cost vs the benefit of various diagnostic procedures in the evaluation of patients with carcinoma of unknown primary site. In an era with an increasing focus on the cost-effectiveness of therapy, this article is one of a burgeoning number of analyses aimed at optimizing the use of the American health care dollar. It is likely that diseases considered to be poorly treated, both malignant and nonmalignant, will be frequent targets for such analysis.
For most patients with carcinoma of unknown primary site, treatment remains relatively ineffective. It has been well documented that once the diagnosis of metastatic cancer is established, the yield of extensive radiologic and endoscopic procedures in identifying a primary site is low. All current textbooks of internal medicine and medical oncology recommend a limited diagnostic evaluation, including only a routine chemistry profile, hemogram, chest