title: Implementation of endoscopic ultrasound for lung cancer staging.
abstract: BACKGROUND
  EUS-guided FNA is currently advocated in lung cancer staging guidelines as an alternative for surgical staging to prove mediastinal metastases. To date, training requirements for chest physicians to obtain competency in EUS for lung cancer staging are unknown.
  
  
  OBJECTIVE
  To test a training and implementation strategy for EUS for the diagnosis and staging of lung cancer.
  
  
  METHODS
  Prospective national multicenter implementation trial. Nine (chest) physicians from 5 hospitals participated in a dedicated EUS educational program (investigation of 50 patients) for the diagnosis and staging of lung cancer. EUS outcomes of trainees were compared with those of the training center.
  
  
  METHODS
  Four general hospitals, the national cancer center (implementation centers), and a tertiary referral center (expert center).
  
  
  METHODS
  This study involved 551 consecutive patients with (suspected) lung cancer, all candidates for surgical staging, who underwent EUS in 1 of the 5 implementation centers (n = 346) or the single expert center (n = 205). Surgical-pathological staging was the reference standard in case no mediastinal metastases were found.
  
  
  RESULTS
  EUS had a sensitivity of 83% versus 82% and accuracy of 89% versus 88% for mediastinal nodal staging (implementation center vs expert center). Surgery was spared because of EUS findings in 51% versus 54% of patients. A single complication occurred in each group.
  
  
  CONCLUSIONS
  Surgical-pathological verification of mediastinal nodes was not available in all patients staged negative at EUS.
  
  
  CONCLUSIONS
  Chest physicians who participate in a dedicated training and implementation program for EUS in lung cancer staging can obtain results similar to those of experts for mediastinal nodal staging.
authors.affiliation: Division of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands. j.t.annema@lumc.nl
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Annema
authors.forename: Roman
authors.initials: R
authors.lastname: Bohoslavsky
authors.forename: Sjaak
authors.initials: S
authors.lastname: Burgers
authors.forename: Marianne
authors.initials: M
authors.lastname: Smits
authors.forename: Babs
authors.initials: B
authors.lastname: Taal
authors.forename: Ben
authors.initials: B
authors.lastname: Venmans
authors.forename: Hans
authors.initials: H
authors.lastname: Nabers
authors.forename: Ben
authors.initials: B
authors.lastname: van de Borne
authors.forename: Roland
authors.initials: R
authors.lastname: van Balkom
authors.forename: Tjeerd
authors.initials: T
authors.lastname: Haitjema
authors.forename: Alle
authors.initials: A
authors.lastname: Welling
authors.forename: Gerald
authors.initials: G
authors.lastname: Staaks
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: Harm
authors.initials: H
authors.lastname: van Tinteren
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies