Learning EBUS-TBNA – A 6-year experience at a single institution

Abstract

Introduction: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has become an important diagnostic tool for the pulmonologist. At our institution, five bronchoscopists have performed EBUS-TBNA during the first 6 years of experience (2008-13) in an unselected patient population. On-site cytological evaluation (ROSE) was introduced in 2011. Aim: A retrospective evaluation of the diagnostic quality of the method and the learning profile during the first years. Methods: EBUS-TBNA procedures from our database were analysed for clinical data. Results: A total of 711 EBUS-TBNA were included. The percentage of EBUS-TBNA with adequate specimen for cytological diagnosis initially decreased the first years, before increasing to a final result of 82,4%. There was a lower proportion of EBUS-TBNA with adequate samples in the benign group (76,8%). Final diagnoses were lung cancer 53%, reactive lymphadenopathies 18,3%, sarcoidosis 17,4% and other malignancy 11,3%. The sensitivity detecting malignancy given adequate samples was 94,8%, specificity 100%, positive predictive value 100%, negative predictive value 81,2% and diagnostic accuracy 95,8%. The percentage of re-examinations declined from 17,1-8,2%. ![Figure][1] Conclusion: After an initial run-in period with lower results, the diagnostic yield of EBUS-TBNA increased. This may be explained by increasing experience, introducing ROSE and finding the correct indication for EBUS-TBNA. [1]: pending:yes