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: Linear endobronchial ultrasound is a safe and effective method for diagnostic sampling of mediastinal lymph nodes. However, there is a learning curve associated with the procedure and diagnostic yield can be influenced by operator experience. We wanted to determine if trainee involvement during EBUS procedure influences procedure characteristics, complication rate and diagostic yield.
METHODS: A retrospective analysis of a database of 220 subjects who underwent an EBUS procedure at our center under conscious sedation. The database was compiled for a study that compared the nasal and oral routes of insertion of EBUS bronchoscope. Local anesthesia was performed using lidocaine. Sedation with intravenous midazolam and fentanyl was administered according to an initial weight-based protocol and then as needed during the procedure. Trainee involvement during the procedure was documented. Procedure characteristics and complications were also recorded. Rapid on-site evaluation of cytology was not used and each station was punctured three times using a 21-gauge needle. Diagnostic yield and specimen adequacy were compared between groups.
RESULTS: From November 2012 to June 2013, 220 subjects were included in a database. Trainee involvement was documented for 116 procedures out of 220. Trainees comprised one interventional pulmonary medicine fellow (n=78 procedures) and two senior residents in respirology (n=38 procedures). Patient characteristics, size and number of lymph node stations sampled were similar. Total dose of sedation and complication rate did not differ between groups. EBUS duration was longer (16.0 vs 13.7 min, p=0.002) and total dose of lidocaine used was higher (322.3 vs 304.2 mg, p=0.045) when a trainee was involved. Specimen adequacy rate was comparable between groups (92.0 vs 92.0%, p=0.60). Diagnostic yield was significantly lower with trainee involvement (52.6 vs 68.3% p=0.02).
CONCLUSIONS: Involvement of trainee during EBUS was associated with increased procedure duration and total dose of local anesthesia aministered for the procedure and resulted in a lower diagnostic yield without affecting specimen adequacy rate. This suggests that operator experience influences diagnostic yield for linear EBUS with similar specimen adequacy rates.
CLINICAL IMPLICATIONS: Operator experience may play a role in the diagnostic yield of EBUS procedure that is greater than previously thought. Factors accounting for this difference in yield in presence of adequate samples warrant further investigation.
DISCLOSURE: The following authors have nothing to disclose: Nancy Ferland, Simon Martel, Stephane Beaudoin, Mathieu Simon, Francis Laberge, Antoine Delage
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