Fockens P, Van den Brande J H, van Dullemen H M, van Lanschot J J, Tytgat G N
Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Gastrointest Endosc. 1996 Jul;44(1):58-62. doi: 10.1016/s0016-5107(96)70230-4.
It has been suggested that 50 endosonographic examination are necessary to attain sufficient skill to become accurate in the staging of esophageal carcinoma.
Since July 1991 all esophageal endosonographies have been performed by one investigator. The database, containing all examinations since July 1991, was reviewed to investigate the presence of a learning curve in T-staging of esophageal carcinoma by comparing the endosonographic T-stage with the pathologic T-stage.
From July 1991 until April 1993, 231 endosonographies were performed for esophageal malignancies. Eighty-nine patients had been referred for preoperative staging and underwent surgical exploration. Seventy-one tumors were resected. The patients were split in two groups. Group I consisted of 36 patients examined between July 1991 and April 1992. In this period 100 endosonographies were performed. Group II consisted of 35 patients examined between April 1992 and March 1993. In this period 131 endosonographies were performed. Overall endosonographic T-staging was correct in 70%. The accuracy in group I was 58%; In group II 83% (p < 0.05). Overstaging was equally common in groups I and II (14%). Understaging was common in group I (28%), but rare in group II (3%).
This study shows a definite learning curve for endosonographic T-staging of esophageal carcinoma. Acceptable accuracy rates could only be achieved after 100 examinations.
有人提出，要获得足够的技能以准确进行食管癌分期，需要进行50次内镜超声检查。
自1991年7月起，所有食管内镜超声检查均由一名研究人员进行。通过比较内镜超声T分期与病理T分期，回顾1991年7月以来所有检查的数据库，以研究食管癌T分期中学习曲线的存在情况。
从1991年7月至1993年4月，对食管恶性肿瘤进行了231次内镜超声检查。89例患者被转诊进行术前分期并接受了手术探查。71例肿瘤被切除。患者被分为两组。第一组由1991年7月至1992年4月间接受检查的36例患者组成。在此期间进行了100次内镜超声检查。第二组由1992年4月至1993年3月间接受检查的35例患者组成。在此期间进行了131次内镜超声检查。总体内镜超声T分期的正确率为70%。第一组的准确率为58%；第二组为83%（p<0.05）。I组和II组的过度分期同样常见（14%）。I组常见分期不足（28%），而II组罕见（3%）。
本研究显示了食管癌内镜超声T分期存在明确的学习曲线。只有在进行100次检查后才能达到可接受的准确率。
