Influence of the Learning Effect on the Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes

Leonello Fuso, Francesco Varone, Daniele Magnini, Antonietta Pecoriello, Giuliano Montemurro, Giulia Angeletti, Salvatore Valente

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

The diagnostic yield of conventional transbronchial needle aspiration (TBNA) is characterized by a learning effect. The aim of this retrospective study was to verify whether a learning curve similarly affected the yield of endobronchial ultrasound-guided (EBUS)-TBNA. To this end, we evaluated the sensitivity and diagnostic accuracy of EBUS-TBNA during the first 3 years of activity. Methods: EBUS-TBNA was performed by 2 operators with no previous experience in this technique. Cytologic samples were obtained from mediastinal and hilar lymph nodes enlarged at a chest computed tomography scan and/or with increased fluorodeoxyglucose uptake at computed tomography/positron emission tomography scan in patients with suspected lung cancer. The cytologic diagnosis of EBUS-TBNA samples has been compared with the final diagnosis obtained from further diagnostic procedures, surgery, or clinical-radiologic follow-up. Results: From October 2012 to October 2015, we collected 408 EBUS-TBNA cytologic samples from 313 patients: 223 samples were positive for metastatic involvement and 185 were nonmetastatic. The latter included 137 true-negative and 48 false-negative results. The final diagnosis comprised 271 metastatic and 137 nonmetastatic lymph nodes. The overall sensitivity for cancer was 82% and diagnostic accuracy was 88%. Sensitivity and accuracy per year were as follows: first year, 78% and 82% in 90 nodal samples; second year, 83% and 89% in 144 nodal samples; third year, 85% and 91% in 174 nodal samples. Conclusions: EBUS-TBNA can be considered as a reliable tool even if performed by operators without previous experience in this procedure, and the diagnostic yield continues to increase progressively over a long time.
Original languageEnglish
Pages (from-to)193-199
Number of pages7
JournalJOURNAL OF BRONCHOLOGY & INTERVENTIONAL PULMONOLOGY
Volume24
DOIs
Publication statusPublished - 2017

Keywords

  • Biopsy, Fine-Needle
  • Bronchoscopy
  • Clinical Competence
  • Female
  • Humans
  • Image-Guided Biopsy
  • Lung Neoplasms
  • Lymph Nodes
  • Lymphatic Metastasis
  • Male
  • Mediastinum
  • Middle Aged
  • Retrospective Studies
  • Sensitivity and Specificity
  • Ultrasonography, Interventional

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