PURPOSE:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new flexible bronchoscopic tool for diagnosing mediastinal and hilar adenopathy. Experience with this procedure is expanding in the private practice and community hospital setting. We describe our training, proctoring and subsequent early experience using this technology.
METHODS:We retrospectively reviewed the office medical records of our first 30 patients undergoing the procedure to ensure efficacy and safety. Patient demographics, lymph node size and location, EBUS-TBNA cytology results, complications, final diagnosis and follow-up information were obtained from chart review. We also provide detailed information of our practice setting, training process for EBUS-TBNA, and proctoring process for EBUS-TBNA.
RESULTS:30 patients underwent EBUS-TBNA under conscious sedation with topical anesthetic. 18 patients with confirmed thoracic malignancy were found to have malignant (14 patients) or atypical (4 patients) cytology by EBUS-TBNA. 11 patients with benign thoracic disease had no evidence of malignancy by cytology and during the initial follow-up. 1 patient with stage IIIA lung carcinoma had a negative EBUS-TBNA. For the detection of malignant mediastinal or hilar nodes, EBUS-TBNA had a diagnostic sensitivity of 94.73% and specificity of 100%. The positive predictive value was 100% and negative predictive value was 91.66%. No clinically significant complications were noted during or following EBUS-TBNA in our first 30 patients.
CONCLUSION:EBUS-TBNA is an easily acquired skill for the community pulmonologists. The training and proctoring described here has adequately prepared us to carry out this procedure with a high degree of accuracy and without complications.
CLINICAL IMPLICATIONS:Our experience may serve as a model for other community pulmonologists adopting this technology.
DISCLOSURE:Phillip Menashe, No Financial Disclosure Information; No Product/Research Disclosure Information