Endorectal ultrasound in XXXX --do the literature results really correspond to the realities of routine clinical care?

@entity5 @entity1 @entity189
BACKGROUND AND STUDY AIMS: This multicenter, prospective, country-wide quality-assurance study at more than 300 hospitals in Germany was designed to characterize and analyze the diagnostic accuracy of rectal endoscopic ultrasound (EUS) in the routine clinical staging of @entity189 (depth of @entity5 infiltration). @entity1 AND METHODS: @entity1 were surveyed between 1 January 2000 and 31 December 2008. Those who received neoadjuvant therapy after EUS were excluded. The correspondence between the EUS assessment of @entity5 depth (uT) and that determined by histology (pT) was calculated, and the influence of hospital volume upon the sensitivity, specificity, and positive and negative predictive values was investigated. RESULTS: At 384 hospitals providing care at all levels, 29206 @entity1 were included; of the 27458 treated by surgical resection, EUS was performed for 12235 (44.6%). Of these, 7096 did not receive neoadjuvant radiochemotherapy, allowing a uT-pT comparison. The uT-pT correspondence was 64.7% (95% confidence interval [CI] 63.6%-65.8%); the frequency of understaging was 18% (95%CI 17.1%-18.9%) and that of overstaging was 17.3% (95%CI 16.4%-18.2%). The kappa coefficient was greatest in the category T1 (k   =   0.591). For T3 @entity5 k was 0.468. The poorest correspondence was found for T2 and T4 @entity5 (k   =   0.367 and 0.321, respectively). A breakdown by hospital volume showed that the uT-pT correspondence was 63.2% (95%CI 61.5%-64.9%) for hospitals undertaking  <=   10   EUS/year, 64.6% (95%CI 62.9%-66.2%) for doing 11-30   EUS/year, and 73.1% (95%CI 69.4%-76.5%) for those hospitals performing >   30   EUS/year. CONCLUSIONS: In clinical routine, the diagnostic accuracy of transrectal ultrasound in staging @entity189 does not attain the very good results reported in the literature. Only in the hands of diagnosticians with a large case volume of @entity189 @entity1 can EUS lead to therapy-relevant decisions.
