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 -
