ENDOSONOGRAPHIC T-STAGING OF ESOPHAGEAL-CARCINOMA - A LEARNING-CURVE

Background:lt has been suggested that 50 endosonographic examinations are necessary to attain sufficient skill to become accurate in the sta ging of esophageal carcinoma. Methods: Since July 1991 all esophageal endosonographies have been performed by one investigator. The database , containing all examinations since July 1991, was reviewed to investi gate the presence of a learning curve in T-staging of esophageal carci noma by comparing the endosonographic T-stage with the pathologic T-st age. Results: From July 1991 until April 1993, 231 endosonographies we re performed for esophageal malignancies. Eighty-nine patients had bee n referred for preoperative staging and underwent surgical exploration . Seventy-one tumors were resected. The patients were split in two gro ups. Group I consisted of 36 patients examined between July 1991 and A pril 1992. In this period 100 endosonographies were performed. Group I I consisted of 35 patients examined between April 1992 and March 1993. In this period 131 endosonographies were performed. Overall endosonog raphic 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 g roup II (3%). Conclusion: This study shows a definite learning curve f or endosonographic T-staging of esophageal carcinoma. Acceptable accur acy rates could only be achieved after 100 examinations.