BACKGROUND: Following CT, guidelines for staging oesophageal and gastro-oesophageal junction (GOJ) @entity5 recommend endoscopic ultrasonography (EUS), PET-CT and laparoscopy for @entity5 . These recommendations are based on generic utilities, but it is unclear whether the test risk outweighs the potential benefit for some @entity1 . This study sought to quantify investigation risks, benefits and utilities, in order to develop pragmatic, personalized staging recommendations. METHODS: All @entity1 with a histological diagnosis of oesophageal or GOJ @entity5 staged between May 2006 and July 2013 comprised a development set; those staged from July 2013 to July 2014 formed the prospective validation set. Probability thresholds of altering management were calculated and predictive factors identified. Algorithms and models (decision tree analysis, logistic regression, artificial @entity1274 ) were validated internally and independently. RESULTS: Some 953 @entity1 were staged following CT, by @entity419 PET-CT (918), EUS (798) and laparoscopy (458). Of these @entity1 , 829 comprised the development set (800 PET-CT, 698 EUS, 397 laparoscopy) and 124 the validation set (118 PET-CT, 100 EUS, 61 laparoscopy). EUS utility in the 71  8 per cent of @entity1 with T2-T4a disease on CT was minimal (0  4 per cent), its risk exceeding benefit. EUS was moderately accurate for @entity2558   N0 disease. A number of factors predicted @entity3 on PET-CT and laparoscopy, although none could inform an algorithm. PET-CT altered management in 23  0 per cent, and laparoscopy in 7  1 per cent, including those with @entity5 . CONCLUSION: Although EUS provided additional information on T and N category, its risk outweighed potential benefit in @entity1 with T2-T4a disease on CT. Laparoscopy seemed justified for @entity5 of T2 or greater.

Pragmatic staging of XXXX using decision theory involving selective endoscopic ultrasonography, PET and laparoscopy.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity2558 :: ('58492', 'Gene') :: ['pT1'] @entity419 :: ('MESH:D019788', 'Chemical') :: ['[(18) F]fluorodeoxyglucose'] @entity5 :: ('MESH:D009369', 'Disease') :: ['distal oesophageal tumours', 'cancer', 'T2 and distal oesophageal tumours', 'T3-T4 GOJ tumours'] @entity1274 :: ('MESH:D006319', 'Disease') :: ['neural networks'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases']
@entity5 :: (MESH:D009369,Disease) :: ['oesophageal cancer']
