The objective of our study was to assess a single operator's learning curve with regard to the number of passes, the diagnostic accuracy, and the complications associated with EUS-guided FNA (EUS-FNA) of solid pancreatic masses.
The number of passes, the diagnostic accuracy, and the complication rate were prospectively evaluated in 300 consecutive EUS-FNA of solid pancreatic masses performed by a single endosonographer over a 3-year period. The procedures were placed into 3 groups, which contained 100 procedures each. The endosonographer had undergone a third-tier EUS fellowship and had performed 45 supervised pancreatic EUS-FNA during his training.
Of the 300 EUS-FNA performed (median age 63 years, 64% men), no statistically significant differences among the 3 groups with regard to age, gender, race, location, or size of the mass were found. Diagnostic accuracy of the EUS-FNA procedure was similar over time (Group 1, 92%; Group 2, 92%; Group 3, 95%). Median number of passes showed a decreasing trend over the 3-year study period, despite an increasing trend of the number of procedures performed (r = -0.14, p = 0.42). The median number of passes was lower for Group 2 (median, 3; p = 0.02) and Group 3 (median, 3; p = 0.003) compared with Group 1 (median, 4). Group 3 (7/100, 7%) was less likely to encounter complications compared with Group 1 (13/100, 13%; p = 0.24) and Group 2 (18/100, 18%; p = 0.03). Frequency of serious complications was similar across the 3 groups (1%-3%).
With adequate third-tier training, a newly developed EUS program can achieve safe and accurate results of EUS-FNA of the pancreas. The learning curve, however, needs to continue after the fellowship, because more procedures are needed for one to gain proficiency and efficiency with EUS-FNA.
"In a study of 57 patients who underwent EUS-FNA by a self-taught endosonographer, the diagnostic sensitivities for malignancy from the first to the last 10 quintiles were 30%, 40%, 70%, 90%, and 80%, respectively . In second study of 300 consecutive patients who underwent EUS-FNA by a trained endosonographer, the median number of passes required to establish a diagnosis decreased significantly with operator experience but without any difference in diagnostic accuracy . This suggests that while the diagnostic accuracy may plateau over time, the procedural expertise continues to improve with experience. "
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasound-guided fine needle aspiration is a multistep procedure that involves proper clinical indication, correct selection of needles, adapting evidence-based techniques such as the fanning maneuver and not routinely using suction or the stylet for tissue sampling, and establishing reliable cytopathology support. Integrating cytopathology in the training curriculum and developing a more flexible platform of needles and echoendoscopes are likely to further advance the field of endosonography. This review aims to summarize the technical issues that are key to performing high-quality endoscopic ultrasound-guided fine needle aspiration.
Electronic supplementary material
The online version of this article (doi:10.1007/s12325-014-0129-5) contains supplementary material, which is available to authorized users.
Advances in Therapy 06/2014; 31(7). DOI:10.1007/s12325-014-0129-5 · 2.27 Impact Factor
"Recent studies have demonstrated that the learning curve for proficiency may be much more than what was previously anticipated. A study by Eloubeidi and Tamhane showed that after 1 year of formal EUS training (including supervision of over 300 EUS and 45 EUS-FNA), the median number of passes to achieve a diagnosis significantly decreased after 100 additional FNA procedures and that complication rates decreased after 200 additional procedures. "
[Show abstract][Hide abstract] ABSTRACT: Like any other technique, fine needle aspiration (FNA) proficiency requires adequate experience. Although this technique is not difficult to master, formal training will allow endosonographers to achieve better results. The following article is derived in two parts: (1) To review current knowledge on endoscopic ultrasound (EUS)-FNA training, discuss the current recommendations on training guidelines, explore other training adjuncts and review the latest studies evaluating the validity of current recommendations; and (2) to provide some basic grounds on the EUS-FNA technique. EUS-FNA can be broken down into a series of steps. Proper execution of each step will make FNA easier and likely increase its diagnostic yield. Adequate positioning of the lesion in regards to the ultrasound probe is a key factor to obtain best results. The following will discuss useful tips in order to achieve maximal success rates.
03/2014; 3(1):12-16. DOI:10.4103/2303-9027.127123
"Factors influencing adequacy per lesion are numerous. Endosonographist experience, beside is influence on being able to access the lesion, have been shown to influence sampling quality by reducing number of needed pass. Over the last decade, many papers have addressed the influence of needle choice and needle utilization on sample adequacy or bloodiness. "
[Show abstract][Hide abstract] ABSTRACT: Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.
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