Abstract
BackgroundMethods available for assessing the learning curve, such as a predefined number of procedures or direct mentoring are lacking. Our aim was to describe the use of a statistical method to identify the minimal training length of an experienced sonographer, newly trained in deep infiltrating endometriosis (DIE) mapping by evaluating the learning curve of transvaginal ultrasound (TVUS) in the preoperative assessment of endometriosis.MethodsA retrospective study in a tertiary referral center for endometriosis. Reports and stored data from TVUS scans performed by one operator with training in general gynecological ultrasound, but not in endometriosis mapping, were analyzed retrospectively for patients who subsequently underwent laparoscopy, which served as a reference standard. The performance of TVUS was assessed for the following sites: endometriomas, bladder, vagina, pouch of Douglas, bowel and uterosacral ligaments, and correlated with laparoscopic findings. Sensitivity, specificity, PPV, NPV, and accuracy were calculated, and the operator’s diagnostic performance was assessed using the learning curve cumulative summation test (LC-CUSUM).ResultsData from 94 women were available for analysis. The learning curve using the LC-CUSUM graph showed that the sonographer reached the predefined level of proficiency in detecting endometriosis lesions after 20, 26, 32, 31, 38, and 44 examinations for endometriomas, bladder nodules, vaginal nodules, pouch of Douglas obliteration, bowel nodules, and uterosacral ligament nodules, respectively.ConclusionsLC-CUSUM allows monitoring of individual performance during the learning process of new methodologies. This study shows that a sonographer trained in general gynecologic ultrasonography, who devotes time to learn TVUS for DIE mapping, can achieve proficiency for diagnosing the major types of endometriotic lesions after examining less than 50 patients who subsequently undergo surgery in a training setting.
Highlights
Methods available for assessing the learning curve, such as a predefined number of procedures or direct mentoring are lacking
This study evaluated the performance of dedicated transvaginal ultrasound (TVUS) for the diagnosis of endometriosis and deep infiltrating endometriosis (DIE)
All the examinations were performed by the same sonographer with previous experience in gynecological ultrasound but without previous experience in DIE mapping expect for an introductory course
Summary
Methods available for assessing the learning curve, such as a predefined number of procedures or direct mentoring are lacking. Endometriosis is a common benign gynecological condition with a prevalence rate of up to 15% [1] in reproductive age women. It is defined as the presence of endometrial tissue, glands and stroma outside the endometrial cavity. Deep infiltrating endometriosis (DIE) is defined as endometriotic lesions that penetrate more than 5 mm from under the peritoneum [1]. These may be multifocal and are most commonly found in the uterosacral ligaments, posterior vaginal fornix, retro cervical region, rectovaginal septum, vesicouterine pouch, bladder, and anterior wall of the recto sigmoid
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