Pulmonary Procedures |

Learning Curve of Conventional TBNA (C-TBNA) in a Community Practice FREE TO VIEW

Elif Küpeli, MD; Pinar Seyfettin, MD; Merih Demirel, MD
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Baskent University School of Medicine, Pathology Department, Ankara, Turkey

Chest. 2014;146(4_MeetingAbstracts):739A. doi:10.1378/chest.1971399
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SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: C-TBNA is minimally invasive, safe, and cost-effective in evaluating mediastinal lymphadenopathy(MLN). Lack of availability, affordability and scope to acquire EBUS-TBNA skills make bronchoscopists rely on C-TBNA. C-TBNA skills can be acquired from the books. Study was performed to understand learning-curve for C-TBNA when skills are acquired without formal training.

METHODS: Results of first 99 consecutively performed C-TBNAs for MLN(>10 mm) were prospectively collected. Patients were divided into: Group-I: first 33, Group-II: #34-66 and Group-III: last 33. Results categories were: Malignant, Non-malignant or Non-diagnostic. Both, malignant and benign diagnoses were considered “True-Positive” if matched clinical suspicion, else further testing ruled out “False-Positives”. Dry-taps and material not representative for above categories were considered non-diagnostic; final diagnoses were established by mediastinoscopy, TTNA, peripheral LN and/or EBB. Aspirates with normal lymphocytes constituted “true negative”, if no diagnosis was established by above methods.

RESULTS: 99 pts(M:F= 62:37), age 58.2±11.5(27-78) underwent C-TBNA; LN diameter 26.9+9.8mm. 69 pts had LNs>20mm in diameter. LN stations were:4R=30, 7= 43 and 11=26. Final diagnosis was established by C-TBNA in 44, mediastinoscopy 47, TTNA 5, EBB 2, peripheral LNBx 2. TBNA was exclusively diagnostic in 35.4% and one dry tap. In Group-I diagnostic yield was 42.4%, 64.7% in malignancies, 19 % in benign conditions(p= 0.008). In Group-II the yield was 54.5%, 88.2% in malignancies, 19 % benign conditions(p = 0.000). In Group-III yield was 36.4%, exclusively in 27%; 100% in malignancies,16% in benign conditions. No difference was found in relation to LN size or location and the yield. The sensitivity, specificity, PPV, NPV and accuracy were: Group-1: 70%,100%,81.2%,100% and 66.7% , Group-II: 89.5%,100%,94%,100% and 87.5% respectively and Group-III all values 100%.

CONCLUSIONS: Accuracy of C-TBNA improves with experience, reaching 100% between 67-99 procedures, among pts with LN size of 27+/-10mm at 4R, 7 and 11stations. Diagnostic- yield depends upon prevalence of malignancy in study population.

CLINICAL IMPLICATIONS: Learning curve of C-TBNA is short and steep. Utility of C-TBNA remains high in practices with limited educational and technical resources.

DISCLOSURE: The following authors have nothing to disclose: Elif Küpeli, Pinar Seyfettin, Merih Demirel

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