- 作者：Evelyn P.M. van Vliet ; Marinus J.C. Eijkemans ; Jan-Werner Poley ; Ewout W. Steyerberg ; Ernst J. Kuipers ; Peter D. Siersema
- 刊名：Gastrointestinal Endoscopy
- 出版年：2006
- 出版时间：June 2006
- 年：2006
- 卷：63
- 期：7
- 页码：938-947
- 全文大小：191 K
Background
It is well known that a learning curve exists for performing EUS.Objective
To determine whether the number of EUS investigations performed in a center affects the results of esophageal cancer staging.
Design
We compared EUS in the evaluation of T stage and the presence of regional and celiac lymph nodes in a low-volume center where <50 EUS/endoscopist/y were performed with reported results from 7 high-volume EUS centers.
Setting
A reference center for esophageal cancer (>90 cases/y) but a low-volume center for EUS when it comes to individual endoscopists.
Patients
From 1994 to 2003, 244 patients underwent EUS, without specific measures to pass a stenotic tumor or FNA and with postoperative TNM stage as the criterion standard in the low-volume EUS center. In the high-volume centers, 670 EUS investigations for esophageal cancer were performed, if needed, with dilation, and with postoperative TNM stage and/or FNA as the criterion standard.
Interventions
Retrospective analysis.
Main Outcome Measurements
Sensitivity and specificity of EUS for esophageal cancer staging.
Results
In the low-volume center, results of EUS for T3 staging in patients in whom passage of the EUS probe was possible were almost comparable for sensitivity (85 % vs 88 % -94 % ) but were lower for specificity (57 % vs 75 % -90 % ), whereas both sensitivity (58 % vs 75 % -90 % ) and specificity (87 % vs 94 % -97 % ) for T1 or T2 stages were lower than those reported in the high-volume centers. In the low-volume center, sensitivities of EUS for regional (45 % vs 63 % -89 % ) and celiac (19 % vs 72 % -83 % ) lymph nodes were lower, whereas specificities (75 % vs 63 % -82 % and 99 % vs 85 % -100 % , respectively) were comparable with those from high-volume centers. Results in the low-volume EUS center were worse if the EUS probe could not pass the stricture, which occurred in almost 30 % of patients.
Limitations
Both FNA and dilation before EUS for stenotic tumors were not performed in the low-volume EUS center.
Conclusions
The results of EUS performed in a low-volume EUS center compared unfavorably with those reported from high-volume EUS centers. The results of this study suggest that preoperative staging by EUS should be performed by experienced and dedicated EUS endoscopists to optimize staging of esophageal cancer.