Transesophageal ultrasonography for lung cancer staging: learning curves of pulmonologists.
BACKGROUND
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.
*Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark; †Pulmonology Department, Leiden University Medical Center, Leiden, The Netherlands, and Pulmonology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ‡Department of Surgical Gastroenterology, Copenhagen University Hospital, Herlev, Denmark; §Department of Pulmonology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; and ‖The Wilson Centre, University of Toronto and University Health Network, Toronto, Canada.
Lars
L
Konge
Jouke
J
Annema
Peter
P
Vilmann
Paul
P
Clementsen
Charlotte
C
Ringsted
D000328:Adult; D001999:Bronchoscopy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008175:Lung Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010819:Physician's Role; D011379:Prognosis; D011446:Prospective Studies; D015272:Pulmonary Medicine