Impact of endoscopic ultrasonography and physician specialty on the management of patients with esophagus cancer
| Autor: | Steven R. Alberts, Claude Deschamps, Enrique Vazquez-Sequeiros, Alan R. Zinsmeister, Robert C. Miller, Angels Ginès, Joseph A. Murray, Michael G. Haddock, Yvonne Romero, Teresa Zais, J.F. Quevedo, Francis C. Nichols, Stephen D. Cassivi, Frank A. Sinicrope, Cathy D. Schleck, James A. Martenson, Mark S. Allen, J. A. Alexander |
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| Rok vydání: | 2008 |
| Předmět: |
Endoscopic ultrasound
Adult Male medicine.medical_specialty Esophageal Neoplasms Biopsy Fine-Needle Specialty Physical examination Medical Oncology Article Endosonography medicine Humans Prospective Studies Esophagus Practice Patterns Physicians' Prospective cohort study Aged Aged 80 and over medicine.diagnostic_test business.industry Gastroenterology Cancer Thoracic Surgery General Medicine Esophageal cancer Middle Aged medicine.disease digestive system diseases medicine.anatomical_structure Cardiothoracic surgery Female Radiology Esophagoscopy business |
| Zdroj: | Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus. 21(3) |
| ISSN: | 1442-2050 |
| Popis: | While endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for locoregional staging of esophageal cancer, little evidence exists that these innovations impact on clinical care. The objective on this study was to determine the frequency with which EUS and EUS-FNA alter the management of patients with localized esophageal cancer, and assess practice variation among specialists at a tertiary care center. Three gastroenterologists, three medical oncologists, three radiation oncologists and four thoracic surgeons were asked to independently report their management recommendations as the anonymized staging information of 50 prospectively enrolled patients from another study were sequentially disclosed on-line. Compared to initial management recommendations, that were based upon history, physical examination, upper endoscopy and CT scan results, EUS prompted a change in management 24% (95% CI: 12–36%) of the time; usually to a more resource-intensive approach (71%), for example from recommending palliation to recommending neoadjuvant chemoradiation therapy. EUS-FNA plus cytology results altered management an additional 8% (95% CI: 6–15%) of the time. Agreement between specialists ranged from fair (intraclass correlation [ICC = 0.32) to substantial (ICC = 0.65); improving with additional information. Among specialists, agreement was greatest for patients with stage I disease. EUS and EUS-FNA changed patient management the most for patients with stages IIA, IIB or III disease. EUS, with or without FNA, significantly impacts the management of patients with localized esophageal cancer. With respect to the optimal treatment for each patient, agreement among physicians incrementally increases with endoscopic ultrasound results. Specialty training appears to influence therapeutic decision-making behavior. |
| Databáze: | OpenAIRE |
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