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Rebuttal From Drs Kinsey and ChannickRebuttal From Drs Kinsey and Channick

C. Matthew Kinsey, MD; Colleen L. Channick, MD
Author and Funding Information

From the Pulmonary and Critical Care Unit, Massachusetts General Hospital, and Harvard Medical School.

Correspondence to: Colleen L. Channick, MD, Pulmonary Special Procedures Unit, Massachusetts General Hospital, 55 Fruit St, Bigelow 952, Boston, MA 02114; e-mail: cchannick@partners.org


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):894-895. doi:10.1378/chest.12-2465
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Extract

We read with interest the editorial of Drs Folch and Majid.1 Much of their argument that >50 supervised procedures should be required for an operator to be deemed competent to perform endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for lung cancer staging relies on the evidence from two correspondences to the editor describing the initial experience of three operators. Despite not performing any prior supervised procedures, Fernández-Villar et al2 reported that the average sample adequacy reached by the two operators was 87% between 40 and 60 procedures. In comparison, sampling adequacy of lymph nodes via EBUS-TBNA in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) Bronchoscopy Registry in high volume centers (>276 TBNAs per year) was 90%.3 Medford4 describes the experience of one operator, who attained a diagnostic accuracy of 85% in the first 20 procedures. The accuracy after performing 81 to 100 cases was only slightly better at 90%.4 These data suggest that the learning curve for EBUS-TBNA “flattens out” relatively early.

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