Staging accuracy of endoscopic ultrasound performed by nonexpert endosonographers in patients with resectable esophageal squamous cell carcinoma: is it possible?
The accuracy of endoscopic ultrasound (EUS) is operator-dependent. According to learning curve study, the accuracy of EUS T-staging for esophageal cancer has been reported to be greater in an investigator who had performed at least 100 EUS examinations. We determined comparative study regarding T-staging accuracy of EUS for esophageal squamous cell carcinoma between expert and nonexpert endoscopic ultrasonographers. We retrospectively identified 73 consecutive patients with esophageal squamous cell carcinoma who underwent EUS and endoscopic mucosal resection, endoscopic submucosal dissection, or surgery. EUS was performed by expert (Group 1) and nonexpert (Group 2) endoscopic ultrasonographers in multitertiary hospitals. Groups 1 and 2 were 37 and 36 patients during 2005-2011, respectively. Forty-two patients (57.5%) of the overall patients underwent surgical exploration. Correct endoscopic ultrasonographic T-staging of Group 1 was observed in 34 (91.9%) patients, while that of Group 2 was observed in 26 (72.2%) patients. And there was significant difference in correct endoscopic ultrasonographic T-staging between Group 1 and Group 2 (P = 0.035). The incorrect endoscopic ultrasonographic T-staging of Group 1 were three cases that were overstaging (8.1%), but in Group 2 there were seven overstaging (19.4%) and three understaging (8.3%). There was no significant difference in overstaging or understaging of incorrect endoscopic ultrasonographic T-staging between Group 1 and Group 2 (P = 0.528). This study first provides evidence that endoscopic ultrasonographic T-staging of nonexpert endoscopic ultrasonographers was inferior to be correct, compared with that of expert endoscopic ultrasonographers. EUS staging for esophageal cancer should be performed by expert endoscopic ultrasonographers to provide appropriate management strategy.
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
W C
WC
Lee
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
T H
TH
Lee
Department of Internal Medicine, College of Medicine, Kyunghee University, Seoul, Korea.
J Y
JY
Jang
Division of Biostatistics, College of Medicine, Soonchunhyang University, Seoul, Korea.
J-S
JS
Lee
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
J Y
JY
Cho
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
J S
JS
Lee
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
S R
SR
Jeon
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
H G
HG
Kim
Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Korea.
J-O
JO
Kim
Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
Y K
YK
Cho
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D019160:Endosonography / Q000592:standards* / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D056910:Republic of Korea; D012189:Retrospective Studies
endoscopic ultrasound; esophageal squamous carcinoma; staging accuracy