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The assessment of endosonographers in training

World Journal of Clinical Cases 2018年第14期6卷 735-744页

作者： per hedenstrom Riadh Sadik Division of Gastroenterology Department of MedicineSahlgrenska University HospitalGothenburg 41345Sweden

Endosonography （EUS） has an estimated long learning curve including the acquisition of both technical and cognitive skills. Trainees in EUS must learn to master intraprocedural steps such as echoendoscope handling and ultrasonographic imaging with the interpretation of normal anatomy and any pathology. In addition, there is a need to understand the periprocedural parts of the EUS-examination such as the indications and contraindications for EUS and potential adverse events that could occur post-EUS. However, the learning process and progress vary widely among endosono-graphers in training. Consequently, the performance of a certain number of supervised procedures duringtraining does not automatically guarantee adequate competence in EUS. Instead, the assessment of EUS-competence should preferably be performed by the use of an assessment tool developed specifically for the evaluation of endosonographers in training. Such a tool, covering all the different steps of the EUS-procedure, would better depict the individual learning curve and better refect the true competence of each trainee. This mini-review will address the issue of clinical education in EUS with respect to the evaluation of endosonographers in training. The aim of the article is to provide an informative overview of the topic. The relevant literature of the field will be reviewed and discussed. The current knowledge on how to assess the skills and competence of endosonographers in training is presented in detail.

关键词： Endosonography Fine-needle aspiration Education Assessment Educational Learning curve Clinical competence Quality indicators

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Characterizing gastrointestinal stromal tumors and evaluating neoadjuvant imatinib by sequencing of endoscopic ultrasound-biopsies

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World Journal of Gastroenterology 2017年第32期23卷 5925-5935页

作者： per hedenstrom Bengt Nilsson Akif Demir Carola Andersson Fredrik Enlund Ola Nilsson Riadh Sadik Division of Medical Gastro-enterology Department of Internal MedicineSahlgrenska University Hospital Department of Surgery Sahlgrenska University Hospital Department of Clinical Pathology and Genetics Sahlgrenska University Hospital

AIM To evaluate endoscopic ultrasound(EUS)-guided biopsies for the pretreatment characterization of gastrointestinal stromal tumors(GIST) to personalize the management of *** All patients with lesions suspected to be GIST who were referred for EUS-sampling at a tertiary Swedish center were eligible for inclusion 2006-2015. During the observational study phase(2006-2011), routine fine-needle-aspiration(EUS-FNA) was *** 2012-2015, we converted to an interventional, randomized protocol with dual sampling EUS-FNA and fine-needle-biopsy-sampling(EUS-FNB) for all lesions. c-KIT-and DOG-1-immunostaining was attempted in all samples and a manual count of the Ki-67-index was performed. FNB-sampled tissue and the resected specimens were subjected to Sanger sequencing of the KIT and platelet-derived growth factor alpha(PDGFRA) genes. RESULTS In all, 64 unique patients with GIST were included, and of these, 38 were subjected to pretreatment dual sampling. EUS-FNB had a higher diagnostic sensitivity when compared head-to-head with EUS-FNA(98% vs 58%, P < 0.001) and was more adequate for Ki-67-indexing(Ki-67EUS)(92% vs 40%, P < 0.001). Sequencing of EUS-biopsies was successful in 43/44(98%) patients, and the mutation profiles(KIT-mutation 73%, PDGFRA-mutation 18%, wild-type 7%) were fully congruent with those detected in the corresponding resected specimens. In imatinib-na?ve patients, the Ki-67_(EUS) was comparable with the Ki-67-index in the corresponding surgical specimens(Ki-67_(SURG))(2.7% vs 2.9%, P = 0.68). In patients treated with neoadjuvant imatinib who also carried mutations indicating sensitivity, the Ki-67 EUS was higher than the Ki-67_(SURG)(2.5% vs 0.2%, P = 0.005), with a significant reduction in the Ki-67-index of-91.5%(95%CI:-82.4 to-96.0, P = 0.005). CONCLUSION EUS-guided biopsy sampling is accurate for the pretreatment diagnosis and characterization of GISTs and allows the prediction and evaluation of tumor response to neoadjuvant imatini

关键词： Endosonography Fine-needle biopsy Gastrointestinal stromal tumor KIT Platelet-derived growth factor alpha Tumor proliferation rate Ki-67 index Neoadjuvant treatment Imatinib

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