BACKGROUND: EUS is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure. The learning curve for the staging of gastric cancer, however, has not been evaluated. OBJECTIVE: To evaluate the threshold number of EUS examinations for gastric cancer T staging. DESIGN: Retrospective study. SETTING: University-affiliated tertiary care hospital in the Republic of Korea. PATIENTS: Four trainees with no previous EUS experience. INTERVENTION: Analyzing performance of EUS trainees in gastric cancer T staging by using cumulative sum (CUSUM) analysis. MAIN OUTCOME MEASUREMENTS: CUSUM plot and a minimal number of procedures for reaching a plateau. RESULTS: A total of 553 initial EUS examinations for treatment-naïve gastric cancers, performed by trainees, were enrolled in the study. The final T stage was determined by experts by using EUS in 332 gastric cancer cases, whereas the T stage of the other 221 lesions was determined by trainees by using EUS. The accuracy of EUS examinations performed by trainees and experts was 72.6% and 84.3%, respectively. The number of EUS examinations required to reach the first plateau in each trainee was 20, 41, 60, and 65. LIMITATIONS: Retrospective study with a relatively small number of trainees. CONCLUSION: The CUSUM scores of all of 4 trainees in the study reached a plateau by the 65th examination.
BACKGROUND: EUS is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure. The learning curve for the staging of gastric cancer, however, has not been evaluated. OBJECTIVE: To evaluate the threshold number of EUS examinations for gastric cancer T staging. DESIGN: Retrospective study. SETTING: University-affiliated tertiary care hospital in the Republic of Korea. PATIENTS: Four trainees with no previous EUS experience. INTERVENTION: Analyzing performance of EUS trainees in gastric cancer T staging by using cumulative sum (CUSUM) analysis. MAIN OUTCOME MEASUREMENTS: CUSUM plot and a minimal number of procedures for reaching a plateau. RESULTS: A total of 553 initial EUS examinations for treatment-naïve gastric cancers, performed by trainees, were enrolled in the study. The final T stage was determined by experts by using EUS in 332 gastric cancer cases, whereas the T stage of the other 221 lesions was determined by trainees by using EUS. The accuracy of EUS examinations performed by trainees and experts was 72.6% and 84.3%, respectively. The number of EUS examinations required to reach the first plateau in each trainee was 20, 41, 60, and 65. LIMITATIONS: Retrospective study with a relatively small number of trainees. CONCLUSION: The CUSUM scores of all of 4 trainees in the study reached a plateau by the 65th examination.
Authors: Alicia S Borggreve; Lucas Goense; Hylke J F Brenkman; Stella Mook; Gert J Meijer; Frank J Wessels; Marcel Verheij; Edwin P M Jansen; Richard van Hillegersberg; Peter S N van Rossum; Jelle P Ruurda Journal: Br J Radiol Date: 2019-03-05 Impact factor: 3.039