PURPOSE: To review the impact of an endobronchial ultrasound (EBUS) program on specimen adequacy, diagnostic yield and training of fellows in transbronchial needle aspirations (TBNA) at a large academic institution.
METHODS: A retrospective review of all TBNA performed at the Johns Hopkins Hospital from 2/06 until 12/09 was performed. From 9/06 through 8/07 only conventional TBNA (cTBNA) was performed. An Interventional Pulmonology (IP) program started in 9/07 introduced EBUS-TBNA to our institution. The total number of cTBNA vs. EBUS-TBNA, specimen adequacy (presence of lymphocytes or diagnostic tissue), diagnostic yield (presence of neoplastic cells or other diagnostic finding, i.e. granuloma) and fellow involvement was recorded.
RESULTS: Prior to starting an IP program (2/06 through 7/07), 162 cTBNA procedures were performed. Specimen adequacy was 67%. Diagnostic yield was 55%. Fellows were involved in 87% of cTBNA cases. After initiation of the IP program and EBUS from 8/07 until 12/09, there were a total of 585 TBNA performed with the majority of these (78%) with EBUS. During this period, EBUS TBNA adequacy was 89% and diagnostic yield was 82%. Fellows were involved in 65% of EBUS cases but 90% of these were by the IP fellow after the IP training program was started in 1/09. During this same time period there were 130 cTBNA performed (22% of total TBNA cases), 48% were adequate specimens with only 42% yielding a diagnosis. Fellows were involved in 77% of the cTBNA cases.
CONCLUSION: The EBUS-TBNA program increased the specimen adequacy and diagnostic yield at out institution (p< 0.05). With the institution of an IP training program, the number of pulmonary fellows involved in all TBNA cases has steadily declined.
CLINICAL IMPLICATIONS: Given the diagnostic advantage using EBUS-TBNA, centers that incorporate EBUS must decide if most TBNA procedures should be done with EBUS; perhaps limiting the number of attending physicians performing these procedures in the model of a center of excellence. Although fellows should understand the basics of cTBNA, the focus of TBNA training should be geared towards EBUS.
DISCLOSURE: Emily Brigham, No Financial Disclosure Information; No Product/Research Disclosure Information