Appendix (Figure 10). Recommended sequence of diagnostic testing in patients who are at high risk for surgical complications, according to pretest probability, computed tomography (CT) results, and threshold that determines cost-effectiveness. Test selection is shown to be a function of pretest probability and the corresponding post-test probability once the results of CT are known. Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) is recommended over a wider range of post-test probabilities when societal willingness to pay is $100 000 per quality-adjusted life-year (QALY) gained. Note that surgery is preferred when PET results are positive, biopsy is preferred when PET results are negative, and watchful waiting is preferred when biopsy results are nondiagnostic.

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