The Society of Thoracic Surgeons recently released a new guideline on the diagnosis and staging of esophageal cancer.
For diagnosis, the guideline said, flexible endoscopy with biopsy is the preferred method. Regarding staging, the following recommendations were made:
In early-stage cancer, computed tomography of the chest and abdomen and positron emission tomography are considered optional staging tests. In locoregionalized cancer, computed tomography of the chest and abdomen and positron emission tomography are recommended staging tests.
Endoscopic ultrasonography is recommended to improve clinical staging accuracy in patients without metastatic disease.
For small, discrete nodules or dysplasia limited to the mucosa or submucosa on endoscopic ultrasonography, endoscopic mucosal resection should be considered for diagnosis/staging.
Laparoscopy is recommended to improve staging accuracy in locally advanced disease of the esophagogastric junction infiltrating the cardia or Siewart type III esophagogastric tumors.
The full guideline, which appears in the July Annals of Thoracic Surgery, is available online.