Pulmonary Procedures |

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Christina Bellinger, MD; Edwards Haponik, MD; Arjun Chatterjee, MD; Norman Adair, MD
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Wake Forest Baptist Health, Winston Salem, NC

Chest. 2013;144(4_MeetingAbstracts):810A. doi:10.1378/chest.1692973
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To determine the number of procedures needed to achieve proficiency at EBUS-TBNA among skilled bronchoscopists and trainees.

METHODS: A retrospective review of all EBUS-TBNAs was performed at our medical center since implementing the use of endobronchial ultrasound.

RESULTS: Our academic center performed EBUS-TBNA on 161 patients sampling 240 nodes. Mean age was 62 years and the majority of patients were male (57%). Overall yield improved from 66% to 80% (p=0.02) and cancer yield improved from 34% to 46% (p=0.05). Yield varied by type of performer. Attending physicians exceeding twenty procedures had higher overall yields (85%) compared to those who performed less than twenty procedures (85% vs 59%, p=0.003). Of those exceeding twenty procedures, their yield rose after the first twenty procedures (74% to 87%, p=0.039). Yield did not vary depending on year of training of the fellow performing the procedure (75% 1st, 84% 2nd, 80% 3rd year, p=0.58) but did improve with individual fellow experience (yield rose from 74% to 90% (p=0.036) after ten procedures). Yield was higher if the Interventional Pulmonary fellow was the primary performer (87% vs 75%, p=0.04).

CONCLUSIONS: There is an overall improvement in EBUS-TBNA yield with increasing experience. Higher yields were seen with more experienced attending physicians. A significant improvement in yield occurred after 10-20 procedures.

CLINICAL IMPLICATIONS: Our study indicates that 10-20 procedures may be sufficient to achieve proficiency suggesting that consideration be given to revising the current guidelines recommending 50 procedures are needed to achieve proficiency. Further studies are needed to determine the number of procedures needed to maintain proficiency.

DISCLOSURE: The following authors have nothing to disclose: Christina Bellinger, Edwards Haponik, Arjun Chatterjee, Norman Adair

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