CUMULATIVE SUM (CUSUM) ANALYSIS IN THE ASSESSMENT OF TRAINEE COMPETENCE IN EUS-GUIDED TISSUE SAMPLING OF SOLID TUMORS IN THE UPPER GASTROINTESTINAL TRACT

Aims Recently, the European Society of Gastrointestinal Endoscopy proposed a minimum of 250 endosonographic (EUS) and 75 fine-needle aspiration/biopsy (FNA/B) procedures to reach adequate competency. We aimed to assess the learning curve of EUS-FNA/B in solid tumors of the upper gastrointestinal tract.

Methods Consecutive patients undergoing FNA/B of solid pancreatic and non-pancreatic tumors were prospectively enrolled in a single-center (on-site cytopathologist was not available). Four trainees participated in the study, two of them reached the recommended threshold for competency (>250 EUS,>75 FNA/Bs) over the study period. The final diagnosis was determined by cytopathology, histopathology, or clinical follow-up. The learning curve was assessed by the cumulative sum analysis.

Results 308 EUS-FNA/Bs of solid tumors (69.2% malignant) were enrolled in 267 patients (median age 68 years, 60.7% males): 227 pancreatic, 34 submucosal, 23 lymph nodes, and 24 other tumors. Overall, 19 samples were insufficient (adequacy 93.8%). The accuracy and sensitivity for detecting malignancy were 217/289 (75.1%) and 169/213 (79.3%). After 70 attempts, a downward deviation due to predominantly positive outcomes was observed, indicating the adequate proficiency of the examinators (Fig. 1). Compared to competent endosonographers, there was a significant difference in the duration of the procedure (33.5 vs. 40.4 min, p<0.0001), and numerically lower accuracy for tumors<20 mm (85.7% vs. 53.5%, p=0.06) and sampling via the trans-duodenal route (86.1% vs. 74.8%, p=0.23).

Conclusions During the EUS training, at least 70 FNA/B attempts in solid upper gastrointestinal tumors were needed to reach the acceptable level of performance.

Fig. 1

Publication History

Article published online:
14 April 2022