Learning Curve for Ultrasound Assessment of Myometrial Infiltration in Endometrial Cancer Visualizing Videoclips: Potential Implications for Training

Abstract

Background: Diagnostic accuracy for estimating myometrial infiltration by ultrasound in endometrial cancer requires experience. The objective of this study is to determine the learning curve (LC) for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS). Methods: Five trainees (one staff radiologist and four fourth-year OB/GYN residents) participated in this study. All trainees had experience in performing TVS, but none of them had specific training on the assessment of myometrial infiltration. Trainees were given one specific lecture about the topic, and then they observed videoclips from 10 cases explained by the trainer. After this, all trainees visualized 45 videoclips of uterine ultrasound scans of endometrial cancer cases. The assessment of myometrial infiltration was based on the subjective impression. Definitive histology was used as a reference standard. Trainees stated whether myometrial infiltration was >50% or <50%. LC-CUSUM and standard CUSUM graphics were plotted to determine how many cases were needed to reach competence, allowing a mistake rate of 15%. Results: All trainees completed the study. LC-CUSUM graphics showed that three trainees reached competence at the 33rd, 35th and 36th case, respectively. All three of them kept the process under control after reaching competence. One trainee reached competence but did not maintain it in the cumulative analysis. One trainee did not reach competence. Conclusion: Our study suggests that 30–40 cases would be needed to be trained for assessing myometrial infiltration by TVS by visual interpretation of videoclips by most trainees.

Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with low‐grade endometrioid endometrial cancer: A systematic review and head‐to‐head meta‐analysis

“…Recently, there are numerous publications studying the importance of training programs and the implementation of standardized techniques to evaluate MI in EC via TVS in order to achieve an improvement in diagnostic accuracy 30–32 . Xholi et al 31 conducted a retrospective study in order to evaluate the learning curve for TVS assessment of MI in women with EC.…”

“…Chacón et al 32 studied this learning curve for assessing MI in cases of endometrial cancer using TVS. Five performers (four fourth year obstetrics and gynecology residents and one radiologist) underwent a specific training on the evaluation of MI in EC.…”

“…27 Green et al 28 Recently, there are numerous publications studying the importance of training programs and the implementation of standardized techniques to evaluate MI in EC via TVS in order to achieve an improvement in diagnostic accuracy. [30][31][32] Xholi et al 31 the process under control after reaching this competence. Therefore, they conclude that 30-40 cases would be needed to obtain optimal skills in determining myometrial infiltration.…”