Development of consensus-based diagnostic criteria for NTOS

The diagnosis of neurogenic thoracic outlet syndrome (NTOS) depends upon clinical suspicion, pattern-recognition, and exclusion of more common conditions that have overlapping features. In most patients a diagnosis of NTOS can be made or excluded on the basis of the clinical history, description of symptoms, and physical examination, with the provisional diagnosis being supplemented by a limited number of diagnostic studies. In this chapter we describe ongoing efforts by the Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome (CORE-TOS) to develop and validate diagnostic criteria for NTOS, based on an expert group consensus approach using Delphi methodology, and present a preliminary set of diagnostic criteria. Careful follow-up studies using standardized assessment instruments, particularly through consortium efforts to involve larger number of patients than available at any single center, will provide further insight into the most accurate diagnostic and prognostic criteria for NTOS.