Learning Curve of USgHIFU Ablation for Uterine Fibroids: A Multi-Center Prospective Study.
high-intensity focused ultrasound
learning curve
operation
training
uterine fibroids
Journal
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
ISSN: 1550-9613
Titre abrégé: J Ultrasound Med
Pays: England
ID NLM: 8211547
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
revised:
05
06
2022
received:
31
10
2021
accepted:
19
06
2022
pubmed:
9
7
2022
medline:
22
11
2022
entrez:
8
7
2022
Statut:
ppublish
Résumé
To verify the stability of high-intensity focused ultrasound (HIFU) technology and the feasibility of training programs with learning curve cumulative summation (LC-CUSUM). A total of 12 physicians and 720 cases were equally assigned to the learning group and the control group, with 6 physicians and 360 cases per group. The learning group was treated by physicians without HIFU experience and the control group was treated by experienced physicians. Nonperfused volume (NPV) ratio was assessed by contrast-enhanced magnetic resonance imaging. Technical failure was defined as NPV ratio of uterine fibroids <70% and/or major complication, while <80% was set as a stricter standard of training qualification. LC-CUSUM was used to analyze the learning curve. Physicians with or without HIFU experience in both groups achieved matchable NPV ratios, where a NPV ratio of 92.52% (16.06) was achieved by experienced physicians and 93.82% (16.95) by inexperienced physicians. No major complication was observed. The results of LC-CUSUM analysis showed that, with the standards of the NPV ratio of 70% or 80%, the learning group mastered the technique on the 11th case and the 16th case, respectively, while the control group was stable. HIFU technology stayed stable in operation, with good safety and sound effectiveness, and was easy to learn. NPV ratio of 70% was considered as an appropriate indicator of training qualification. HIFU has remarkable prospects in achieving a NPV ratio of ≥80% without safety being compromised.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3051-3059Subventions
Organisme : Chongqing Medical University Intelligent Medicine Project
ID : ZHYX2019007
Informations de copyright
© 2022 American Institute of Ultrasound in Medicine.
Références
Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011; 113:3-13.
Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124:1501-1512.
Stewart EA. Clinical practice. Uterine fibroids. N Engl J Med 2015; 372:1646-1655.
Ter Haar G. HIFU tissue ablation: concept and devices. Adv Exp Med Biol 2016; 880:3-20.
Kennedy JE. High-intensity focused ultrasound in the treatment of solid tumours. Nat Rev Cancer 2005; 5:321-327.
Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria-a 10-year update. Radiology 2014; 273:241-260.
Cheung VYT. High-intensity focused ultrasound therapy. Best Pract Res Clin Obstet Gynaecol 2018; 46:74-83.
Zhang L, Zhang W, Orsi F, Chen W, Wang Z. Ultrasound-guided high intensity focused ultrasound for the treatment of gynaecological diseases: a review of safety and efficacy. Int J Hyperthermia 2015; 31:280-284.
Chen J, Li Y, Wang Z, et al. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: an IDEAL prospective exploration study. BJOG 2018; 125:354-364.
Verpalen IM, de Boer JP, Linstra M, et al. The focused ultrasound myoma outcome study (FUMOS); a retrospective cohort study on long-term outcomes of MR-HIFU therapy. Eur Radiol 2020; 30:2473-2482.
Liu Y, Wu X, Wu A, Gong C, Wang Z, Zhang L. Ultrasound-guided high intensity focused ultrasound ablation for uterine fibroids: long-term outcomes and factors affecting local recurrence. Int J Hyperthermia 2021; 38:1341-1348.
Stewart EA, Gostout B, Rabinovici J, Kim HS, Regan L, Tempany CM. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 2007; 110(2 Pt 1):279-287.
Biau DJ, Williams SM, Schlup MM, Nizard RS, Porcher R. Quantitative and individualized assessment of the learning curve using LC-CUSUM. Br J Surg 2008; 95:925-929.
Lee YK, Biau DJ, Yoon BH, Kim TY, Ha YC, Koo KH. Learning curve of acetabular cup positioning in total hip arthroplasty using a cumulative summation test for learning curve (LC-CUSUM). J Arthroplasty 2014; 29:586-589.
Guerriero S, Pascual MA, Ajossa S, et al. Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program. Ultrasound Obstet Gynecol 2019; 54:262-269.
Rölfing JD, Jensen RD, Paltved C. HipSim-hip fracture surgery simulation utilizing the learning curve-cumulative summation test (LC-CUSUM). Acta Orthop 2020; 91:669-674.
Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 2005; 25:21-40.
Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14:S199-S202.
Chen J, Chen W, Zhang L, et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: a review of 9988 cases. Ultrason Sonochem 2015; 27:671-676.
Valsamis EM, Chouari T, O'Dowd-Booth C, Rogers B, Ricketts D. Learning curves in surgery: variables, analysis and applications. Postgrad Med J 2018; 94:525-530.
Bolsin S, Colson M. The use of the Cusum technique in the assessment of trainee competence in new procedures. International J Qual Health Care 2000; 12:433-438.
Kestin IG. A statistical approach to measuring the competence of anaesthetic trainees at practical procedures. Br J Anaesth 1995; 75:805-809.
Sultana A, Nightingale P, Marudanayagam R, Sutcliffe RP. Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM. HPB 2019; 21:1505-1512.
Sims AJ, Keltie K, Burn J, Robson SC. Assessment of competency in clinical measurement: comparison of two forms of sequential test and sensitivity of test error rates to parameter choice. International J Qual Health Care 2013; 25:322-330.