You get what you expect?: A critical appraisal of imaging methodology in endosonographic cancer staging

被引:93
作者
Meining, A
Dittler, HJ
Wolf, A
Lorenz, R
Schusdziarra, V
Siewert, JR
Classen, M
Höfler, H
Rösch, T
机构
[1] Tech Univ Munich, Dept Internal Med 2, Klinikum Rechts Isar, D-81675 Munich, Germany
[2] Tech Univ Munich, Dept Surg, Klinikum Rechts Isar, D-81675 Munich, Germany
[3] Tech Univ Munich, Dept Pathol, Klinikum Rechts Isar, D-81675 Munich, Germany
关键词
D O I
10.1136/gut.50.5.599
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and aims: After an initial period of excellent results with newly introduced imaging procedures, the accuracy of most imaging methods declines in later publications. This effect may be due to various methodological factors involved in the research. Using the example of endoscopic ultrasound (EUS), this study aimed to elucidate one of the factors possibly concerned-namely, the extent to which the examiners are adequately blinded. Methods: Well documented videotapes of EUS examinations of 101 patients with resected tumours of the oesophagus (n=32), stomach (n=33), or pancreas (n=36) were evaluated in three different ways: firstly, retrospective analysis under routine clinical conditions; secondly, evaluation of EUS videotapes in a strictly blinded fashion; and thirdly, evaluation of the some videotapes but with additional information from the video endoscopic appearance (oesophageal/gastric cancer) or from computed tomography results (pancreatic cancer). Histopathological T staging was used as the reference method. Results: The accuracy of EUS in T staging was 73% under routine conditions. This value fell significantly to 53% for the blinded evaluation but increased again to 62% for the unblinded evaluation. The sensitivity of staging T1/T2 tumours was 72% (routine EUS), 59% (blinded EUS), and 70% (unblinded EUS). The respective values for advanced tumours were 85%, 74%, and 72%. Conclusions: The accuracy of EUS for T staging in clinical practice appears to be lower than has previously been reported. In addition, blinded analysis produced significantly poorer results, which improved when another test was added. It may be speculated that better results with routine EUS obtained in a clinical setting are due to additional sources of information.
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页码:599 / 603
页数:5
相关论文
共 32 条
[1]   EUS in preoperative staging of pancreatic cancer [J].
Ahmad, NA ;
Lewis, JD ;
Ginsberg, GG ;
Rosato, EF ;
Morris, JB ;
Kochman, ML .
GASTROINTESTINAL ENDOSCOPY, 2000, 52 (04) :463-468
[2]   Endoscopic ultrasound staging criteria for esophageal cancer [J].
Brugge, WR ;
Lee, MJ ;
Carey, RW ;
Mathisen, DJ .
GASTROINTESTINAL ENDOSCOPY, 1997, 45 (02) :147-152
[3]   EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms [J].
Cannon, ME ;
Carpenter, SL ;
Elta, GH ;
Nostrant, TT ;
Kochman, ML ;
Ginsberg, GG ;
Stotland, B ;
Rosato, EF ;
Morris, JB ;
Eckhauser, F ;
Scheiman, JM .
GASTROINTESTINAL ENDOSCOPY, 1999, 50 (01) :27-33
[4]   Learning curve of transrectal ultrasound [J].
Carmody, BJ ;
Otchy, DP .
DISEASES OF THE COLON & RECTUM, 2000, 43 (02) :193-197
[5]   Preliminary reports and the rates of publication of follow-up reports in peer-reviewed, indexed journals [J].
Cloft, HJ ;
Shengelaia, GG ;
Marx, WF ;
Kallmes, DF .
ACADEMIC MEDICINE, 2001, 76 (06) :638-641
[6]   Pancreatic cancer: Value of dual-phase helical CT in assessing resectability [J].
Diehl, SJ ;
Lehmann, KJ ;
Sadick, M ;
Lachmann, R ;
Georgi, M .
RADIOLOGY, 1998, 206 (02) :373-378
[7]  
Dufour B, 1997, GASTROEN CLIN BIOL, V21, P124
[8]   Factors associated with acceptance and full publication of GI endoscopic research originally published in abstract form [J].
Eloubeidi, MA ;
Wade, SB ;
Provenzale, D .
GASTROINTESTINAL ENDOSCOPY, 2001, 53 (03) :275-282
[9]   Endosonographic T-staging of esophageal carcinoma: A learning curve [J].
Fockens, P ;
VandenBrande, JHM ;
vanDullemen, HM ;
vanLanschot, JJB ;
Tytgat, GNJ .
GASTROINTESTINAL ENDOSCOPY, 1996, 44 (01) :58-62
[10]   PANCREATIC DUCTAL ADENOCARCINOMA - DIAGNOSIS AND STAGING WITH DYNAMIC CT [J].
FREENY, PC ;
MARKS, WM ;
RYAN, JA ;
TRAVERSO, LW .
RADIOLOGY, 1988, 166 (01) :125-133