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Does a learning curve exist in endorectal two-dimensional ultrasound accuracy?

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Abstract

Background

Aim of the study was to assess adequacy of Colorectal Surgical Society of Australia and New Zealand (CSSANZ) endorectal ultrasound (ERUS) training and whether a subsequent learning curve exists.

Methods

A prospective audit of ERUS for staging rectal cancer by a single surgeon from commencement of consultant practice was performed. Data were recorded in a prospectively maintained database. The audit commenced on completion of CSSANZ training. T- and N-stage were assessed clinically, then by ERUS prior to treatment and finally by histology over 8 years.

Results

The results were compared over three time periods: the first a single year, then two three-year periods. Two hundred and seventy-two patients were examined. Two hundred and thirty-three were assessable for T-stage (13 no tumour excision, 26 long course pre-operative radiotherapy) and 142 for N-stage (74 endoanal excision, 17 proximal mesorectum un-assessable). Overall accuracy was 82% for T-stage and 73% for N-stage. Accuracy for T- and N-staging did not change significantly over the three time periods (T: 82.1, 82.3, 81.6%, P = 0.14; N: 83.3, 67.9, 74.2%, P = 0.31). The utility of ERUS was demonstrated by clinical assessment not being possible in 32% of cases and where the two modalities disagreed was correct 82% of the time.

Conclusions

Endorectal ultrasound rectal cancer staging is accurate for T-stage. Competency in ERUS can be achieved in the CSSANZ fellowship and accuracy does not improve with further experience. An ERUS accreditation scheme should be established for future trainees.

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Acknowledgments

The authors would like to thank Dr Peter Stewart, Dr Anthony Eyers and Dr Michael Solomon for their collective input throughout training.

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Authors and Affiliations

  1. Hunter Colorectal Research, Private Medical Suites, 26 Lookout Road, New Lambton, NSW, 2305, Australia

    O. J. Morris, B. Draganic & S. Smith

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  1. O. J. Morris
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Correspondence to O. J. Morris.

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Morris, O.J., Draganic, B. & Smith, S. Does a learning curve exist in endorectal two-dimensional ultrasound accuracy?. Tech Coloproctol 15, 301–311 (2011). https://doi.org/10.1007/s10151-011-0711-7

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