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Al-Halfawy A, Hussein S, Ashur W, El-Hendawi A, Hussein S. Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study. J Cardiothorac Surg 2024; 19:69. [PMID: 38326810 PMCID: PMC10848468 DOI: 10.1186/s13019-024-02560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy. METHODS The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure. RESULTS we found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis. CONCLUSION Lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.
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Affiliation(s)
| | | | - Wafaa Ashur
- Faculty of Medicine, Cairo University, Giza, Egypt
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Ribeiro Neto ML, Arrossi AV, Yadav R, Culver DA, Mukhopadhyay S, Parambil JG, Southern BD, Tolle L, Pande A, Almeida FA, Sahoo D, Glennie J, Ahmad U, Mehta AC, Gildea TR. Prospective cohort of cryobiopsy in interstitial lung diseases: a single center experience. BMC Pulm Med 2022; 22:215. [PMID: 35655191 PMCID: PMC9161499 DOI: 10.1186/s12890-022-01990-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Rationale Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to surgical biopsy.
Objectives To evaluate the diagnostic yield and complications of cryobiopsy in patients selected by multidisciplinary discussion.
Methods This was a prospective cohort from 2017 to 2019. We included consecutive patients with suspected interstitial lung diseases being considered for lung biopsy presented at our multidisciplinary meeting. Measurements and main results Of 112 patients, we recommended no biopsy in 31, transbronchial forceps biopsy in 16, cryobiopsy in 54 and surgical biopsy in 11. By the end of the study, 34 patients had had cryobiopsy and 24 patients, surgical biopsy. Overall pathologic and multidisciplinary diagnostic yield of cryobiopsy was 47.1% and 61.8%, respectively. The yield increased over time for both pathologic (year 1: 28.6%, year 2: 54.5%, year 3: 66.7%, p = 0.161) and multidisciplinary (year 1: 50%, year 2: 63.6%, year 3: 77.8%, p = 0.412) diagnosis. Overall rate of grade 4 bleeding after cryobiopsy was 11.8%. Cryobiopsy required less chest tube placement (11.8% vs 100%, p < 0.001) and less hospitalizations compared to surgical biopsy (26.5% vs 95.7%, p < 0.001), but hospitalized patients had a longer median hospital stay (2 days vs 1 day, p = 0.004). Conclusions Diagnostic yield of cryobiopsy increased over time but the overall grade 4 bleeding rate was 11.8%. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01990-4.
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Zhao Y, Matsui Y, Hiraki T, Iguchi T, Tomita K, Uka M, Gobara H, Toyooka S, Kanazawa S. Computed tomography fluoroscopy-guided cutting needle biopsy of pulmonary nodules ≤8 mm: A retrospective study including 117 nodules. Eur J Radiol 2020; 125:108903. [PMID: 32088660 DOI: 10.1016/j.ejrad.2020.108903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the diagnostic yield and safety of computed tomography (CT) fluoroscopy-guided cutting needle biopsy (CNB) for pulmonary nodules ≤ 8 mm. METHOD Data of CT fluoroscopy-guided CNB for pulmonary nodules ≤ 8 mm performed in a single institution were retrospectively analyzed. One hundred and seventeen biopsy procedures for 117 pulmonary nodules (mean size, 7.4 mm) in 114 patients were included in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Univariate analyses were performed to elucidate the risk factors for diagnostic failure (i.e., non-diagnostic, false-positive, or false-negative results). Complications were graded per the Clavien-Dindo Classification. RESULTS One (0.9 %) non-diagnostic biopsy result was found. The diagnostic accuracy was 95.7 % (112/117). The sensitivity and specificity were 95.8 % (91/95) and 95.5 % (21/22), respectively. PPV and NPV were 98.9 % (91/92) and 87.5 % (21/24), respectively. Univariate analyses showed that nodules in the lower lobes (p = 0.006) and prone biopsy position (p = 0.021) were the significant risk factors for diagnostic failure. The incidence of pneumothorax requiring chest tube placement (Grade IIIa) was 6.8 % (8/117). No Grade IIIb or higher complications were observed. CONCLUSION CT fluoroscopy-guided CNB for pulmonary nodules ≤ 8 mm showed a high diagnostic yield without severe complications.
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Affiliation(s)
- Yanqing Zhao
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Farrag MA, El Assal GM, Madkour AM, Osman NM, Taha MH. Implementation of bronchoscopic conventional transbronchial needle aspiration service in a tertiary care chest hospital. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_95_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sarinc Ulasli S, Koksal D, Karcioglu O, Babaoglu E, Onder S, Emri S. Diagnostic utility of conventional transbronchial needle aspiration in older patients. Eur Geriatr Med 2018; 9:263-267. [PMID: 34654262 DOI: 10.1007/s41999-018-0036-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND In older patients, diagnosis and initial treatment should be considered as soon as possible because of high disease burden and complications. Conventional transbronchial needle aspiration (C-TBNA) is an important and safe method for the diagnosis of mediastinal lesions and staging lung cancer in the general population. We aimed to evaluate the diagnostic utility and complications of C-TBNA procedure in older patients aged ≥ 65 years. METHOD We retrospectively evaluated C-TBNA results consecutively. Demographic data, clinical, radiological and flexible bronchoscopy (FB) findings, complications during C-TBNA and incidence of diagnostic C-TBNA with the presence of abundant lymphoid cells of polymorphous appearance both in patients aged ≥ 65 years and in younger patients were determined. RESULTS C-TBNA was performed to a total of 317 patients, including 109 older and 208 younger patients attended to our clinic between 2012 and 2016. The mean ages of older and younger patients were 70.3 ± 4.6 and 52.5 ± 10 years, respectively (p < 0.001). Overall, 75.2% of older and 80.3% of younger patients had diagnostic C-TBNA. The diagnostic utility of C-TBNA did not differ significantly between older and younger patients (p = 0.297). During C-TBNA, one older patient had a complication of bronchospasm, and four younger patients had complications such as bleeding (n = 1) and bronchospasm (n = 3). There was no statistically significant difference between older and younger patients in terms of complications during C-TBNA procedure (p = 0.49). CONCLUSION C-TBNA is a safe procedure with similar diagnostic yield in older patients.
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Affiliation(s)
- Sevinc Sarinc Ulasli
- Department of Pulmonary Diseases, Hacettepe University, School of Medicine, Ankara, Turkey.
| | - Deniz Koksal
- Department of Pulmonary Diseases, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Oguz Karcioglu
- Department of Pulmonary Diseases, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Elif Babaoglu
- Department of Pulmonary Diseases, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sevgen Onder
- Department of Pathology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Salih Emri
- Department of Pulmonary Diseases, Hacettepe University, School of Medicine, Ankara, Turkey.,Department of Pulmonary Diseases, Altinbas University, School of Medicine, Istanbul, Turkey
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Ramieri MT, Marandino F, Visca P, Salvitti T, Gallo E, Casini B, Giordano FR, Frigieri C, Caterino M, Carlini S, Rinaldi M, Ceribelli A, Pennetti A, Alò PL, Marino M, Pescarmona E, Filippetti M. Usefulness of conventional transbronchial needle aspiration in the diagnosis, staging and molecular characterization of pulmonary neoplasias by thin-prep based cytology: experience of a single oncological institute. J Thorac Dis 2016; 8:2128-37. [PMID: 27621869 PMCID: PMC4999774 DOI: 10.21037/jtd.2016.07.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Conventional transbronchial needle aspiration (c-TBNA) contributed to improve the bronchoscopic examination, allowing to sample lesions located even outside the tracheo-bronchial tree and in the hilo-mediastinal district, both for diagnostic and staging purposes. METHODS We have evaluated the sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the c-TBNA performed during the 2005-2015 period for suspicious lung neoplasia and/or hilar and mediastinal lymphadenopathy at the Thoracic endoscopy of the Thoracic Surgery Department of the Regina Elena National Cancer Institute, Rome. Data from 273 consecutive patients (205 males and 68 females) were analyzed. RESULTS Among 158 (58%) adequate specimens, 112 (41%) were neoplastic or contained atypical cells, 46 (17%) were negative or not diagnostic. We considered in the analysis first the overall period; then we compared the findings of the first [2005-2011] and second period [2012-2015] and, finally, only those of adequate specimens. During the overall period, sensibility and accuracy values were respectively of 53% and 63%, in the first period they reached 41% and 53% respectively; in the second period sensibility and accuracy reached 60% and 68%. Considering only the adequate specimens, sensibility and accuracy during the overall period were respectively of 80% and 82%; the values obtained for the first period were 68% and 72%. Finally, in the second period, sensibility reached 86% and accuracy 89%. Carcinoma-subtyping was possible in 112 cases, adenocarcinomas being diagnosed in 50 cases; further, in 30 cases molecular predictive data could be obtained. CONCLUSIONS The c-TBNA proved to be an efficient method for the diagnosis/staging of lung neoplasms and for the diagnosis of mediastinal lymphadenopathy. Endoscopist's skill and technical development, associated to thin-prep cytology and to a rapid on site examination (ROSE), were able to provide by c-TBNA a high diagnostic yield and molecular predictive data in advanced lung carcinomas.
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Affiliation(s)
| | | | - Paolo Visca
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Tommaso Salvitti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Claudia Frigieri
- Anaesthesia and Intensive Care Complex Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Caterino
- Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Sandro Carlini
- Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Rinaldi
- Medical Oncology “B” Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Ceribelli
- Medical Oncology “A” Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Annarita Pennetti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Pier Luigi Alò
- Department of Pathology, “F. Spaziani” Hospital, ASL Frosinone, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Filippetti
- Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
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Küpeli E, Seyfettin P, Tepeoğlu MD. Conventional transbronchial needle aspiration: From acquisition to precision. Ann Thorac Med 2015; 10:50-4. [PMID: 25593608 PMCID: PMC4286846 DOI: 10.4103/1817-1737.146873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/13/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Conventional transbronchial needle aspiration (C-TBNA) is a minimally invasive, safe, and cost-effective technique in evaluating mediastinal lymphadenopathy. Previously we reported that the skills for C-TBNA can be acquired from the books. We studied the learning curve for C-TBNA for a single bronchoscopist at a tertiary-care center where ultrasound technology remains difficult to acquire . METHODS We prospectively collected results of the first 99 consecutively performed C-TBNA between December 2009 and 2013. Patients were divided into 3 groups: (I): First 33, (II): Next 33 and (III): Last 33. Results were categorized as malignant, non-malignant or non-diagnostic. Diagnostic yield (DY), sensitivity (SEN), specificity (SPE), positive and negative predictive values (PPV, NPV), and accuracy (ACC) were calculated to learn the learning curve for C-TBNA. RESULTS Total 99 patients (M:F = 62:37), mean age 58.2 ± 11.5 years, mean LN diameter 26.9 ± 9.8 mm underwent C-TBNA. Sixty-nine patients had lymph nodes (LNs) >20 mm in diameter. Final diagnoses were established by C-TBNA in 44 (yield 44.4%), mediastinoscopy 47, transthoracic needle aspiration 5, endobronchial biopsy 2 and peripheral LN biopsy 1. C-TBNA was exclusively diagnostic in 35.4%. Group I: DY: 42.4%, 64.7% in malignancies, 19% in benign conditions (P = 0.008). SEN, SPE, PPV, NPV, ACC = 70%, 100%, 100%, 66.6%, 78.7%, respectively. Group II: DY: 54.5% (36.4% exclusive), 88.2% in malignancies and 19% benign conditions (P = 0.000). SEN, SPE, PPV, NPV, ACC=72%, 100%, 100%, 53.3%, 78.7%, respectively. Group III: DY: 36.3% (27% exclusive), 100% in malignancies and 16% in benign conditions. SEN, SPE, PPV, NPV, ACC = 92.3%, 100%, 100%, 95.2%, 97%, respectively. No difference was found in relation to LN size or location and TBNA yield. CONCLUSION C-TBNA can be easily learned and the proficiency can be attained with <66 procedures. In selected patients, its exclusivity could exceed 35%.
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Affiliation(s)
- Elif Küpeli
- Department of Pulmonary, Baskent University School of Medicine, Ankara, Turkey
| | - Pınar Seyfettin
- Department of Pulmonary, Baskent University School of Medicine, Ankara, Turkey
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Xia Y, Ma Y, Arias S, Lee H, Wang KP. Utilization of the International Association for the Study of Lung Cancer and Wang's nodal map for the identification of mediastinum and hilar lymph nodes. Thorac Cancer 2015; 6:464-8. [PMID: 26273402 PMCID: PMC4511325 DOI: 10.1111/1759-7714.12206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 10/31/2014] [Indexed: 12/25/2022] Open
Abstract
Background Transbronchial needle aspiration (TBNA), serving as a remarkably invaluable and minimally invasive technique, has been widely used for the diagnosis and staging of mediastinal adenopathy and masses. To date, the International Association for the Study of Lung Cancer (IASLC) and Wang's nodal map are two well-documented intrathoracic lymph node guidelines for the TBNA procedure. Method We characterized IASLC's and Wang's map, and interpreted the correlation of the two maps station by station. Results The pivotal role of IASLC map is to determine N descriptor in the tumor node metastasis (TNM) staging system of lung cancer, whilst Wang's map is employed to facilitate the localization of biopsy sites for bronchoscopists during TBNA performance. Furthermore, stations 1, 3 and 5 in Wang’ map are equivalent to 4R station in IASLC’ system, while stations 4 and 6 in Wang's account for IASLC station 4L as N2 stations. In addition, Wang's stations 2, 8 and 10 are correlated with station 7 in IASLC's. Wang's stations 7 and 9 are responsible for station 11R in IASLC's map. Conclusion Given their unique benefits and limitations, and the practical links between the two maps, it appears reasonable to highlight the significance of their complementary utilization upon TBNA performance and lung cancer staging.
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Affiliation(s)
- Yang Xia
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou, Zhejiang, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Yun Ma
- Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University Zhengzhou, Henan, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Sixto Arias
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Hans Lee
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Ko-Pen Wang
- Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University Zhengzhou, Henan, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
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Bellinger CR, Chatterjee AB, Adair N, Houle T, Khan I, Haponik E. Training in and experience with endobronchial ultrasound. Respiration 2014; 88:478-83. [PMID: 25402619 DOI: 10.1159/000368366] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosing mediastinal and hilar lymphadenopathy and staging lung cancer with endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) are on the rise, but uncertainty surrounds the optimal number of cases needed to achieve acceptable yields. OBJECTIVES To determine the threshold at which EBUS-TBNA reaches adequate yields among trainees and skilled bronchoscopists. METHODS We reviewed all EBUS-TBNAs performed at our medical center since implementing the use of EBUS (n = 222). RESULTS EBUS-TBNAs were performed in 222 patients (344 nodes). The percentage of adequate specimens sampled (diagnostic specimens or nodal tissue) rose from 66% in 2008 to 90% in 2012 (p < 0.01) and cancer yield improved from 34% in 2008 to 48% in 2012 (p < 0.01). Attending physicians who performed an average of more than 10 procedures per year had higher yields compared to those who performed fewer than 10 procedures per year (86 vs. 68%, p < 0.01). The yield of trainees also improved with every 10 procedures (79, 90 and 95%, p < 0.001) and that of attending physicians with experience (1-25 procedures: 78% yield, 26-50 procedures: 87% yield and 50+ procedures: 90% yield; p < 0.01). Among trainees, failure rates declined steadily. CONCLUSION EBUS-TBNA yield (malignant and benign) increases with increasing experience amongst experienced bronchoscopists and trainees as early as the first 20-25 procedures. Pulmonary trainees had a rapid decline in failure rates. These findings suggest that in an academic environment a minimum of 20-25 procedures is needed to achieve acceptable yields.
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Affiliation(s)
- Christina R Bellinger
- Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Winston Salem, N.C., USA
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