Quality standard

Quality statement 3: Assessment after endoscopy and CT scan

Quality statement 3: Assessment after endoscopy and CT scan

Quality statement

Adults with oesophageal or oesophago-gastric junctional tumours (except T1a tumours) for whom radical treatment is suitable, have 18‑fluorodeoxyglucose positron emission tomography (F‑18 FDG PET‑CT) requested and reported within 1 week.

Rationale

F‑18 FDG PET‑CT staging after endoscopy and whole-body CT allows the more accurate detection of metastatic disease. This helps to determine whether the disease is suitable for radical treatment, or whether it is too advanced. Timely requesting and reporting of F‑18 FDG PET‑CT will help avoid unnecessary investigations for staging (such as endoscopic ultrasound) in adults with metastatic oesophago-gastric cancer and oesophago-gastric junctional cancer, and delays to treatment.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of the availability of equipment and systems to request and report the results of F‑18 FDG PET‑CT scans.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols and referral pathways.

b) Evidence of local processes to identify F‑18 FDG PET‑CT scans reported more than 1 week after they have been requested.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications and local protocols.

Process

Proportion of adults with oesophageal or oesophago-gastric junctional cancer for whom radical treatment is suitable who have staging using F‑18 FDG PET‑CT with results reported within 1 week of the decision to request the scan.

Numerator – the number of adults in the denominator who have the results of F‑18 FDG PET‑CT staging reported within 1 week of the decision to request the scan.

Denominator – the number of adults with oesophageal or oesophago-gastric junctional cancer for whom radical treatment is suitable.

Data source: The National Oesophago-Gastric Cancer Audit collects data for use of PET-CT for people with a curative treatment plan.

Outcome

a) Proportion of adults with oesophageal or oesophago-gastric junctional cancer who have accurate staging.

Numerator – the number in the denominator who have accurate staging.

Denominator – the number of adults with oesophageal or oesophago-gastric junctional cancer who have staging data recorded at diagnosis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The National Oesophago-Gastric Cancer Audit collects data on the stage of the cancer.

b) Proportion of adults with metastatic oesophageal or oesophago-gastric junctional cancer who have endoscopic ultrasound.

Numerator – the number in the denominator who have endoscopic ultrasound.

Denominator – the number of adults with metastatic oesophageal or oesophago-gastric junctional cancer.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, patient records.

What the quality statement means for different audiences

Service providers (specialist oesophago-gastric cancer centres, tertiary care centres) have systems in place for adults with oesophageal and oesophago-gastric junctional tumours (apart from T1a tumours) to have staging using F‑18 FDG PET‑CT, with results reported within 1 week of the decision to scan, if radical treatment is considered suitable after endoscopy and whole-body CT. This allows accurate diagnosis, classification and staging before treatment planning.

Healthcare professionals (radiologists and nuclear medicine physicians) report the results of staging using F‑18 FDG PET‑CT for adults with oesophageal or oesophago-gastric junctional tumours (apart from T1a tumours) within 1 week of the decision to scan. F‑18 FDG PET‑CT more accurately detects metastatic disease, avoids unnecessary further testing and supports treatment planning.

Commissioners ensure that they commission services in which adults with oesophageal or oesophago-gastric junctional tumours (apart from T1a tumours) have staging using F‑18 FDG PET‑CT, with results reported within 1 week of the decision to scan, if radical treatment is considered suitable after endoscopy and whole-body CT.

Adults with oesophageal or oesophago-gastric junctional cancer who are being considered for treatment to remove the cancer have a scan, with the results reported within 1 week of the decision to arrange it. The aim of the scan is to show how far the cancer has spread. If the scan shows that the cancer is advanced, palliative care (for example, palliative radiotherapy) should be planned.

Source guidance

Oesophago-gastric cancer: assessment and management in adults. NICE guideline NG83 (2018, updated 2023), recommendation 1.3.1

The timeframe of 1 week is based on expert consensus. NHS England's Implementing a timed oesophago-gastric diagnostic pathway: a handbook for local health and care systems (pages 9 and 11, footnote 8) aligns with this timeframe.

Definitions of terms used in this quality statement

Radical treatment is suitable

The suitability of radical treatment depends on people having none of the following:

  • metastatic disease identified during earlier staging investigations (whole-body CT scan)

  • comorbidities, reduced fitness or performance status

  • personal preference to avoid surgery or chemoradiotherapy

  • tumour-related issues.

[Adapted from NICE's full guideline on oesophago-gastric cancer, glossary, section 9.1.1; and expert opinion].