title: Diagnostic strategies for pre-treatment staging of patients with oesophageal cancer.
abstract: OBJECTIVE
  Current guidelines for staging oesophageal cancer recommend a series of preoperative investigations. There is no consensus on the recommended order for these investigations or whether all investigations are necessary in all patients. Our aim was to determine an efficient strategy for pre-treatment staging of patients with oesophageal cancer.
  
  
  METHODS
  We retrospectively compared 15 staging strategies, based on all possible orders of all possible subsets of three staging modalities (computed tomography, endoscopic ultrasonography and external ultrasonography of the neck). We assumed that if distant metastases or local irresectability were found and confirmed, no further investigations would be performed. Main outcome was the minimal number of investigations needed to detect all patients with incurable disease.
  
  
  RESULTS
  Using all three investigations in all 412 patients would lead to performance of 1,236 investigations. Both strategies starting with computed tomography or endoscopic ultrasonography and ending with external ultrasonography were most efficient, using a total of 1,112 investigations.
  
  
  CONCLUSIONS
  The use of a conditional staging strategy with a specific order of imaging can reduce the number of tests necessary to identify incurable patients with oesophageal cancer by 10%. In our opinion, this is not enough to recommend implementation of a logistically more complex diagnostic system.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. m.vanheijl@amc.uva.nl
authors.forename: Mark
authors.initials: M
authors.lastname: van Heijl
authors.forename: Jikke M T
authors.initials: JM
authors.lastname: Omloo
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: Nico J
authors.initials: NJ
authors.lastname: Smits
authors.forename: Saffire S K S
authors.initials: SS
authors.lastname: Phoa
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.forename: Gerrit W
authors.initials: GW
authors.lastname: Sloof
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt