Chacón Enrique, Marucco Julia, Martinez Irene, Monroy Alba, Laza Maria Victoria, Tomaizeh Aida, Pascual Maria Ángela, Guerriero Stefano, Alcázar Juan Luis
Department of Obstetrics and Gynecology, Clínica Universitaria De Navarra, 31008 Pamplona, Spain.
Centro de Diagnóstico TCBA, Buenos Aires C1177, Argentina.
Diagnostics (Basel). 2023 Jan 24;13(3):425. doi: 10.3390/diagnostics13030425.
Diagnostic accuracy for estimating myometrial infiltration by ultrasound in endometrial cancer requires experience. The objective of this study is to determine the learning curve (LC) for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS).
Five trainees (one staff radiologist and four fourth-year OB/GYN residents) participated in this study. All trainees had experience in performing TVS, but none of them had specific training on the assessment of myometrial infiltration. Trainees were given one specific lecture about the topic, and then they observed videoclips from 10 cases explained by the trainer. After this, all trainees visualized 45 videoclips of uterine ultrasound scans of endometrial cancer cases. The assessment of myometrial infiltration was based on the subjective impression. Definitive histology was used as a reference standard. Trainees stated whether myometrial infiltration was ≥50% or <50%. LC-CUSUM and standard CUSUM graphics were plotted to determine how many cases were needed to reach competence, allowing a mistake rate of 15%.
All trainees completed the study. LC-CUSUM graphics showed that three trainees reached competence at the 33rd, 35th and 36th case, respectively. All three of them kept the process under control after reaching competence. One trainee reached competence but did not maintain it in the cumulative analysis. One trainee did not reach competence.
Our study suggests that 30-40 cases would be needed to be trained for assessing myometrial infiltration by TVS by visual interpretation of videoclips by most trainees.
通过超声评估子宫内膜癌肌层浸润的诊断准确性需要经验。本研究的目的是确定使用经阴道超声（TVS）评估子宫内膜癌病例肌层浸润的学习曲线（LC）。
五名受训人员（一名放射科工作人员和四名妇产科四年级住院医师）参与了本研究。所有受训人员都有进行TVS的经验，但他们都没有接受过关于肌层浸润评估的专门培训。给受训人员进行了一次关于该主题的特定讲座，然后他们观看了由培训师讲解的10个病例的视频片段。在此之后，所有受训人员观看了45个子宫内膜癌病例的子宫超声扫描视频片段。肌层浸润的评估基于主观印象。最终组织学被用作参考标准。受训人员说明肌层浸润是否≥50%或<50%。绘制LC-CUSUM和标准CUSUM图表以确定达到胜任水平需要多少病例，允许错误率为15%。
所有受训人员都完成了研究。LC-CUSUM图表显示，三名受训人员分别在第33、35和36个病例时达到胜任水平。他们三人在达到胜任水平后都保持了过程的可控性。一名受训人员达到了胜任水平，但在累积分析中没有保持。一名受训人员没有达到胜任水平。
我们的研究表明，大多数受训人员通过视频片段的视觉解读接受TVS评估肌层浸润的培训需要30 - 40个病例。
