Original articleClinical endoscopyImplementation of endoscopic ultrasound for lung cancer staging
Section snippets
Implementation strategy
Initially, several lectures regarding EUS were given at various lung cancer meetings in The Netherlands, with the aim being to disseminate information to chest physicians and lung surgeons on the indications for EUS-FNA in lung cancer staging. Subsequently, 9 physicians from 5 different hospitals were trained to perform EUS. Seven were chest physicians who had neither used US (either transthoracic or endobronchial US [EBUS]) before in clinical practice nor had been exposed to gastroscopy prior
Patient characteristics
Patient characteristics of the 551 patients with suspected lung cancer are summarized in Table 1. The study population in the implementation and expert centers were comparable with respect to age, sex, and location of the lung tumor. In the implementation centers, compared to the expert center, more patients presented with enlarged (short axis >1 cm on CT) (77% vs 60%, respectively) or PET-positive N2/N3 nodes (42% vs 27%, respectively). At inclusion, patients were intended to undergo
Discussion
This implementation trial for EUS-FNA demonstrates that chest physicians, after participating in a rather limited but dedicated EUS implementation program, can obtain results similar to those of experts regarding mediastinal staging of lung cancer. For the assessment of mediastinal metastases, sensitivity (83% vs 82%) and accuracy (89% vs 88%) did not differ between implementation centers and the expert center. Both the implementation centers and expert referral center achieved the high
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DISCLOSURE: Supported by a grant fromThe Netherlands Organisation for Health Research and Development (Zon-Mw), provided to Dr Annema and Dr Rabe. The current study was supported within an initiative of implementation programs aiming to investigate how methods with proven accuracy and cost-effectiveness could be implemented into clinical practice. Zon-Mw had no role in the design of the study, data collection, analysis, or reporting. All authors had full access to the data. All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Annema at [email protected].