Staging of esophageal carcinoma in a low-volume EUS center compared with reported results from high-volume centers.
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.


METHODS
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.


METHODS
A reference center for esophageal cancer (>90 cases/y) but a low-volume center for EUS when it comes to individual endoscopists.


METHODS
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.


METHODS
Retrospective analysis.


METHODS
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.


CONCLUSIONS
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.
van Vliet
Evelyn P M
EP
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
Eijkemans
Marinus J C
MJ
Poley
Jan-Werner
JW
Steyerberg
Ewout W
EW
Kuipers
Ernst J
EJ
Siersema
Peter D
PD
D000368:Aged; D002983:Clinical Competence; D019160:Endosonography / Q000592:standards* / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity