Staging in oesophageal cancer

Accurate staging defines groups for stage-specific treatment, minimising inappropriate treatment. Application of dedicated staging methods – including 16–64 multidetector computed tomography (CT), endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) and positron emission tomography (PET) – results in better staging of oesophageal cancer. PET as a metabolic imaging technique that is usually applied after (or recently in combination with) CT (PET/CT) improves the accuracy of non-invasive staging, especially in locally advanced oesophageal cancer patients. Whether EUS-FNA or PET/CT should be performed as a first diagnostic step is still a matter of debate. Fluoro-2-deoxyglucose (FDG) PET is also promising tool in assessing neoadjuvant treatment response. Application of these dedicated staging methods has a learning curve, suggesting a prominent role for centralisation.