To review the impact of starting an endobronchial ultrasound (EBUS) program at an academic institution on the volume and procedural approach to transbronchial needle aspirations (TBNA).
A retrospective review of all transbronchial needle aspirations performed at the Johns Hopkins Hospital from September 2006 until March of 2009 was performed. From September 2006 through August 2007 only traditional TBNA was performed. An Interventional Pulmonology (IP) program was started in September 2007 which introduced EBUS TBNA to our institution. The total number of standard vs EBUS TBNA performed, as well as the number of different attending physicians performing the procedures at our institution was recorded.
In the year prior to the initiation of an IP program (September 2006 through August 2007), there were 166 TBNA procedures performed. After the initiation of the IP program in September 2007 until March 2009, there were a total of 486 TBNA procedures performed reflecting a 107% increase in TBNA procedural volume. 360 of the 486 TBNA procedures performed during this time period were performed with EBUS (p<0.001).Standard TBNA was performed by 17 different attending physicians during the year before EBUS. During this time period, 11 out of the 17 (65%) physicians performed less than 10 procedures. 86 out of the total 166 (52%) standard TBNA procedures were performed by one procedural bronchoscopist at our institution. After the initiation of the IP program, 16 attending physicians performed the 486 TBNA procedures of which 13 (82%) performed less than 10 procedures during this time period. All 360 EBUS TBNA procedures were performed by 2 physicians.
The initiation of a dedicated IP program with EBUS both significantly increased the volume of TBNA procedures, as well as decreased the amount of standard TBNA being performed.
Centers that encorporate EBUS will need to decide on how to train pulmonary fellows with either standard TBNA or EBUS TBNA. It is possible that the volume of standard TBNA will become insufficient for adequate training.
Lonny Yarmus, No Financial Disclosure Information; No Product/Research Disclosure Information