Transesophageal Ultrasonography for Lung Cancer Staging: Learning Curves of Pulmonologists

TY - JOUR

T1 - Transesophageal Ultrasonography for Lung Cancer Staging

T2 - Learning Curves of Pulmonologists

AU - Konge, Lars

AU - Annema, Jouke

AU - Vilmann, Peter

AU - Clementsen, Paul

AU - Ringsted, Charlotte

PY - 2013/11

Y1 - 2013/11

N2 - INTRODUCTION:: Accurate mediastinal nodal staging is essential for patients with resectable non-small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging are unknown. METHODS:: Pulmonologists from Denmark and The Netherlands were enrolled in a dedicated, supervised training program. They performed standardized EUS-FNA procedures for mediastinal nodal analysis and their performances were assessed by EUS experts using a validated EUS assessment tool. Data were collected prospectively and used to plot learning curves and relate these to procedures performed by experienced investigators. RESULTS:: Four participants performed 91 EUS-FNA procedures (range, 19-24). The performances of the participants improved significantly and became more consistent, but were still highly variable even in the latter part of the learning curves. Only two of the participants reached the mean score of experienced operators - after 17 and 23 procedures, respectively. CONCLUSIONS:: Pulmonologists with knowledge of lung cancer staging and experience in bronchoscopy quickly improved their performance of EUS-FNA. However, acquisition of skills varies between individuals, and certification should be based on assessment of performance of multiple cases. Twenty procedures were not enough to secure consistent and competent performance of all trainees.

AB - INTRODUCTION:: Accurate mediastinal nodal staging is essential for patients with resectable non-small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging are unknown. METHODS:: Pulmonologists from Denmark and The Netherlands were enrolled in a dedicated, supervised training program. They performed standardized EUS-FNA procedures for mediastinal nodal analysis and their performances were assessed by EUS experts using a validated EUS assessment tool. Data were collected prospectively and used to plot learning curves and relate these to procedures performed by experienced investigators. RESULTS:: Four participants performed 91 EUS-FNA procedures (range, 19-24). The performances of the participants improved significantly and became more consistent, but were still highly variable even in the latter part of the learning curves. Only two of the participants reached the mean score of experienced operators - after 17 and 23 procedures, respectively. CONCLUSIONS:: Pulmonologists with knowledge of lung cancer staging and experience in bronchoscopy quickly improved their performance of EUS-FNA. However, acquisition of skills varies between individuals, and certification should be based on assessment of performance of multiple cases. Twenty procedures were not enough to secure consistent and competent performance of all trainees.

U2 - 10.1097/JTO.0b013e3182a46bf1

DO - 10.1097/JTO.0b013e3182a46bf1

M3 - Journal article

C2 - 24077453

SN - 1556-0864

VL - 8

SP - 1402

EP - 1408

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

IS - 11

ER -