Marc Bazot MD, Presenter: Nothing to Disclose

Lionel Dessolle MD, Abstract Co-Author: Nothing to Disclose

Marcos Ballester MD, Abstract Co-Author: Nothing to Disclose

David J Biau, Abstract Co-Author: Nothing to Disclose

Emile Darai, Abstract Co-Author: Nothing to Disclose

The diagnosis of endometriomas by transvaginal sonography (TVS) is considered to be easy but the number of procedures required for a trainee to learn this diagnosis is unknown. The purpose of this prospective study was to evaluate the learning curve of TVS for the diagnosis of endometriomas using a specific statistical tool.

Four trainees and an expert sonologist performed TVS examinations to diagnose endometriomas in 176 consecutive patients having a clinical suspicion of pelvic endometriosis. All TVS were monitored by the cumulative summation test for learning curve (LC-CUSUM), a statistical tool designed to indicate when a process has reached a predefined level of performance. The main outcome measure was concordance with the expert sonologist in TVS regarding the presence, size and location of the cysts. An 85% concordance was considered adequate and 70% was inadequate performance. Descriptive statistics of each trainee for the diagnosis of endometriomas confirmed by expert examinations were calculated.

The trainees performed independently 44, 38, 48, and 46 procedures, respectively. The LC-CUSUM showed that three of the four trainees reached adequate performance and that the required level of achievement was obtained after 18, 27, and 40 procedures. Simple and intuitive graphical representations of the LCs were generated. The sensitivity, specificity, and positive and negative predictive values of TVS for the diagnosis of endometriomas by trainees 1, 2, 3 and 4 were 85, 91.7, 88.2, and 100%, 100, 76.9, 93.5, and 92.9%, 100, 64.7, 88.2, and 90%, and 90, 95.2, 93.5, and 100%, respectively.

This study shows that LC-CUSUM can be used to monitor the learning process of TVS for the diagnosis of endometriomas and confirms the large inter-trainee variability of learning curves.

Forty TVS examinations seem necessary for operators with no experience to diagnose endometriomas with a high level of accuracy.

Bazot, M, Dessolle, L, Ballester, M, Biau, D, Darai, E, Learning Curve of Transvaginal Sonography for the Diagnosis of Endometriomas Assessed by Cumulative Summation Test (LC-CUSUM).  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003564.html