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Original Research |

Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle AspirationTransbronchial Needle Aspiration Diagnostic Yield: Results of the AQuIRE Bronchoscopy Registry

David E. Ost, MD, MPH; Armin Ernst, MD, FCCP; Xiudong Lei, PhD; David Feller-Kopman, MD, FCCP; George A. Eapen, MD, FCCP; Kevin L. Kovitz, MD, FCCP; Felix J. F. Herth, MD, FCCP; Michael Simoff, MD, FCCP; on behalf of the AQuIRE Bronchoscopy Registry
Author and Funding Information

From the Department of Pulmonary Medicine (Drs Ost and Eapen) and Biostatistics (Dr Lei), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Pulmonary and Critical Care (Dr Ernst), St. Elizabeth Medical Center, Caritas Christi Health Care, Brighton, MA; the Department of Pulmonary and Critical Care (Dr Feller-Kopman), Johns Hopkins University, Baltimore, MD; the Chicago Chest Center (Dr Kovitz), Elk Grove Village, IL; the Thoraxklinik (Dr Herth), Heidelberg, Germany; and the Department of Pulmonary and Critical Care (Dr Simoff), The Henry Ford Hospital, Detroit, MI.

Correspondence to: David Ost, MD MPH, The University of Texas MD Anderson Cancer Center, Department of Pulmonary Medicine, 1515 Holcombe Blvd, Unit 1462, Houston, TX 77030; e-mail: dost@mdanderson.org

Data presented as No. (%) unless otherwise noted. EBUS-TBNA = endobronchial ultrasound-guided transbronchial needle aspiration; TBNA = transbronchial needle aspiration.

Data presented as No. (%) unless otherwise noted. See Table 1 legend for expansion of abbreviation.

a

The diagnosis of sarcoidosis required the finding of granulomatous inflammation in the appropriate clinical context. The final diagnosis was based on the decision of the attending pulmonologist.

Data presented as No. (%) unless otherwise noted. ASA = American Society of Anesthesiologists; LN = lymph node. See Table 1 legend for expansion of other abbreviations.

Data presented as No. (%) unless otherwise noted. See Table 1 and 3 legends for expansion of abbreviations.

See Table 1 and 3 legends for expansion of abbreviations.

On-site cytologic evaluation was treated as an LN-level variable. See Table 1 and 3 legends for expansion of abbreviations.

Data presented as No. (%) unless otherwise noted. See Table 3 for expansion of abbreviation.

Data presented as No. (%) unless otherwise noted. See Table 3 for expansion of abbreviation.

a

Fisher exact test.

Data presented as No. (%) unless otherwise noted. Letters A-F correspond to participating hospitals. V = annual TBNA volume. See Table 1 and 3 legends for expansion of other abbreviations.

a

Linear regression analysis of mean number and size of LN sites undergoing biopsy based on volume revealed that per one hospital volume increase, the mean number of LN sites undergoing biopsy increased 0.0027 (P = .003), and the largest size of LN undergoing biopsy decreased 0.002 cm (P = .018).

See Table 1 and 9 legends for expansion of abbreviations.

a

Risk-adjusted diagnostic yield was based on indirect standardization using LN size.

Funding/Support: The American College of Chest Physicians (ACCP) funded database construction for the AQuIRE program. The data used for this publication was provided through The ACCP AQuIRE Registry.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: The American College of Chest Physicians (ACCP) funded database construction for the AQuIRE program. The data used for this publication was provided through The ACCP AQuIRE Registry.

Funding/Support: The American College of Chest Physicians (ACCP) funded database construction for the AQuIRE program. The data used for this publication was provided through The ACCP AQuIRE Registry.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1557-1566. doi:10.1378/chest.10-2914
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Published online

Background:  New transbronchial needle aspiration (TBNA) technologies have been developed, but their clinical effectiveness and determinants of diagnostic yield have not been quantified. Prospective data are needed to determine risk-adjusted diagnostic yield.

Methods:  We prospectively enrolled patients undergoing TBNA of mediastinal lymph nodes in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) multicenter database and recorded clinical, procedural, and provider information. All clinical decisions, including type of TBNA used (conventional vs endobronchial ultrasound-guided), were made by the attending bronchoscopist. The primary outcome was obtaining a specific diagnosis.

Results:  We enrolled 891 patients at six hospitals. Most procedures (95%) were performed with ultrasound guidance. A specific diagnosis was made in 447 cases. Unadjusted diagnostic yields were 37% to 54% for different hospitals, with significant between-hospital heterogeneity (P = .0001). Diagnostic yield was associated with annual hospital TBNA volume (OR, 1.003; 95% CI, 1.000-1.006; P = .037), smoking (OR, 1.55; 95% CI, 1.02-2.34; P = .042), biopsy of more than two sites (OR, 0.57; 95% CI, 0.38-0.85; P = .015), lymph node size (reference > 1-2 cm, ≤ 1 cm: OR, 0.51; 95% CI, 0.34-0.77; P = .003; > 2-3 cm: OR, 2.49; 95% CI, 1.61-3.85; P < .001; and > 3 cm: OR, 3.61; 95% CI, 2.17-6.00; P < .001), and positive PET scan (OR, 3.12; 95% CI, 1.39-7.01; P = .018). Biopsy was performed on more and smaller nodes at high-volume hospitals (P < .0001).

Conclusions:  To our knowledge, this is the first bronchoscopy study of risk-adjusted diagnostic yields on a hospital-level basis. High-volume hospitals were associated with high diagnostic yields. This study also demonstrates the value of procedural registries as a quality improvement tool. A larger number and variety of participating hospitals is needed to verify these results and to further investigate other determinants of diagnostic yield.


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