Factors Affecting the Learning Curve in the Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Prospective Study.
Competence
Endosonography
Fine-needle aspiration/biopsy
Learning
Pancreatic tumor
Journal
Gut and liver
ISSN: 2005-1212
Titre abrégé: Gut Liver
Pays: Korea (South)
ID NLM: 101316452
Informations de publication
Date de publication:
15 03 2023
15 03 2023
Historique:
received:
02
12
2021
revised:
01
02
2022
accepted:
15
03
2022
pubmed:
26
11
2022
medline:
17
3
2023
entrez:
25
11
2022
Statut:
ppublish
Résumé
Endosonography is associated with a long learning curve. We aimed to assess variables that may influence the diagnostic outcomes in endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) of solid pancreatic tumors regarding the level of endoscopists' experience. Consecutive patients undergoing EUS-guided puncture of solid pancreatic tumors (eight endosonographers, including six trainees) were prospectively enrolled. An experienced endosonographer was defined as having performed at least 250 EUS examinations, including 75 FNA/Bs. The final diagnosis was determined by cytopathology, histopathology, or clinical follow-up. In total, 283 EUS-FNA/Bs of solid pancreatic tumors (75.6% malignant) in 239 patients (median age 69 years, 57.6% males) were enrolled. Trainees performed 149/283 (52.7%) of the interventions. Accuracy and sensitivity for detecting malignancy were significantly higher in the expert group than in the trainee group (85.8% vs 73.2%, p=0.01 and 82.5% vs 68.4%, p=0.02). Solid lesions evaluated by an expert using FNB needles showed the best odds for a correct diagnosis (odds ratio, 3.07; 95% confidence interval, 1.15 to 8.23; p=0.02). More experienced endoscopists achieved better accuracy in sampling via the transduodenal approach (86.7% vs 68.5%, p<0.001), in the sampling of malignant lesions (82.5 vs 68.4, p=0.02), and in the sampling of lesions located in the pancreatic head (86.1 vs 69.1, p=0.02). In cases involving these factors, we observed a moderate improvement in the diagnostic accuracy after 40 attempts. Transduodenal approach, pancreatic head lesions, and malignancy were recognized as the most important clinical factors affecting the learning curve in EUS-FNA/B of solid pancreatic lesions.
Sections du résumé
Background/Aims
Endosonography is associated with a long learning curve. We aimed to assess variables that may influence the diagnostic outcomes in endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) of solid pancreatic tumors regarding the level of endoscopists' experience.
Methods
Consecutive patients undergoing EUS-guided puncture of solid pancreatic tumors (eight endosonographers, including six trainees) were prospectively enrolled. An experienced endosonographer was defined as having performed at least 250 EUS examinations, including 75 FNA/Bs. The final diagnosis was determined by cytopathology, histopathology, or clinical follow-up.
Results
In total, 283 EUS-FNA/Bs of solid pancreatic tumors (75.6% malignant) in 239 patients (median age 69 years, 57.6% males) were enrolled. Trainees performed 149/283 (52.7%) of the interventions. Accuracy and sensitivity for detecting malignancy were significantly higher in the expert group than in the trainee group (85.8% vs 73.2%, p=0.01 and 82.5% vs 68.4%, p=0.02). Solid lesions evaluated by an expert using FNB needles showed the best odds for a correct diagnosis (odds ratio, 3.07; 95% confidence interval, 1.15 to 8.23; p=0.02). More experienced endoscopists achieved better accuracy in sampling via the transduodenal approach (86.7% vs 68.5%, p<0.001), in the sampling of malignant lesions (82.5 vs 68.4, p=0.02), and in the sampling of lesions located in the pancreatic head (86.1 vs 69.1, p=0.02). In cases involving these factors, we observed a moderate improvement in the diagnostic accuracy after 40 attempts.
Conclusions
Transduodenal approach, pancreatic head lesions, and malignancy were recognized as the most important clinical factors affecting the learning curve in EUS-FNA/B of solid pancreatic lesions.
Identifiants
pubmed: 36424720
pii: gnl210560
doi: 10.5009/gnl210560
pmc: PMC10018312
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
308-317Références
Scand J Gastroenterol. 2021 Feb;56(2):205-210
pubmed: 33355007
Endosc Int Open. 2017 May;5(5):E363-E375
pubmed: 28497108
Endoscopy. 2011 Oct;43(10):897-912
pubmed: 21842456
Eur J Gastroenterol Hepatol. 2022 Feb 1;34(2):177-183
pubmed: 33560681
Gastrointest Endosc. 2019 Jun;89(6):1160-1168.e9
pubmed: 30738985
Gastrointest Endosc. 2001 Dec;54(6):811-4
pubmed: 11726873
Scand J Gastroenterol. 2013 Jul;48(7):877-83
pubmed: 23795663
Gastrointest Endosc. 2007 Jul;66(1):27-34
pubmed: 17591470
J Can Assoc Gastroenterol. 2020 Apr;3(2):83-90
pubmed: 32328547
Gastrointest Endosc. 2005 May;61(6):700-8
pubmed: 15855975
Gastrointest Endosc. 2006 Jun;63(7):966-75
pubmed: 16733111
Endoscopy. 2014 Dec;46(12):1056-62
pubmed: 25098611
Endoscopy. 2021 Oct;53(10):1071-1087
pubmed: 34311472
Gastrointest Endosc. 2002 May;55(6):669-73
pubmed: 11979248
Endoscopy. 2012 Feb;44(2):190-206
pubmed: 22180307
Dig Dis Sci. 2019 Jul;64(7):2006-2013
pubmed: 30604374
Clin Endosc. 2021 May;54(3):420-427
pubmed: 34082488
Surg Endosc. 2017 Jan;31(1):225-230
pubmed: 27194261
Gastrointest Endosc. 2013 Apr;77(4):558-65
pubmed: 23260317
Clin Gastroenterol Hepatol. 2015 Jul;13(7):1318-1325.e2
pubmed: 25460557
Am J Gastroenterol. 2015 Oct;110(10):1429-39
pubmed: 26346868