Impact of Endobronchial Ultrasound (EBUS) Training on the Diagnostic Yield of Conventional Transbronchial Needle Aspiration for Lymph Node Stations 4R and 7

Abstract

BackgroundThere is sparse literature on whether training in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) improves the diagnostic yield of conventional TBNA (cTBNA).ObjectivesThe aim of this study was to evaluate the diagnostic yield of cTBNA before and after the introduction of EBUS.MethodsThis was a retrospective analysis of patients who underwent cTBNA at our center. The study was divided into two periods, before and after the introduction of EBUS at our facility. The diagnostic yield of cTBNA was compared between the study periods. Rapid on-site cytological examination was not available.ResultsA total of 1,050 patients (61.6% men; mean age 45.6 years) underwent cTBNA during the study period (849 before EBUS; 201 after EBUS). Sarcoidosis (n = 527) followed by bronchogenic carcinoma (n = 222) formed the most common indications for performing cTBNA. There was a significant increase in both the success of obtaining a representative sample (from 71% to 85%), and the diagnostic yield (from 33% to 49.5%) of cTBNA, after the introduction of EBUS. The increase in the diagnostic yield of cTBNA after introduction of EBUS remained significant even after adjusting for years of performing cTBNA and the type of anesthesia (topical vs. sedation and topical) on a multivariate analysis.ConclusionThe diagnostic yield of cTBNA at our facility increased after the introduction of EBUS-TBNA. However, given the retrospective nature of the study, prospective studies are required to confirm our findings.

A survey of flexible bronchoscopy practices in India: The Indian bronchoscopy survey (2017)

“…[ 21 22 ] Nearly three-fourth of the respondents were performing conventional TBNA which is an encouraging observation. Studies have demonstrated that conventional TBNA has a reasonable sensitivity,[ 23 ] and when combined with rapid on-site cytological evaluation can provide diagnostic yields similar to EBUS-TBNA. [ 24 ] The performance of chest radiograph following TBLB was very common (85.2%).…”

Utility of Narrow-band Imaging Bronchoscopy in the Diagnosis of Endobronchial Sarcoidosis

“…Patients underwent TBNA (either conventional or EBUS-guided) followed by EBB and TBLB at the operator’s discretion 24–26 . Conventional TBNA was performed through the flexible video bronchoscope using the 21-gauge needle (SmoothShot, Olympus Medical Systems, Japan) 27 . EBUS was performed trans-orally under moderate sedation using the convex probe EBUS scope (BF-UC 180F; Olympus Medical Systems, Tokyo, Japan) with a compatible endoscopic ultrasound scanner (EU-ME1; Olympus Medical Systems, Japan) 6 .…”

“…[24][25][26] Conventional TBNA was performed through the flexible video bronchoscope using the 21-gauge needle (SmoothShot, Olympus Medical Systems, Japan). 27 EBUS was performed trans-orally under moderate sedation using the convex probe EBUS scope (BF-UC 180F; Olympus Medical Systems, Tokyo, Japan) with a compatible endoscopic ultrasound scanner (EU-ME1; Olympus Medical Systems, Japan). 6 We punctured the lymph nodes using a disposable 21-gauge (21G) or 22-gauge (22G) endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needle (Vizi-Shot, NA-201SX-4021/4022, Olympus Medical Systems, Japan) under direct endoscopic and ultrasonographic visualization.…”

Learning curve: Endobronchial ultrasound-guided needle aspiration

“…[ 6 ] However, these data are primarily from countries in the western hemisphere where the predominant disease to affect the mediastinal lymph nodes is malignant, in contrary to India where benign disorders such as tuberculosis and sarcoidosis predominate. [ 7 8 ] Srinivasan et al . showed that with experience, yield improves and they reported sarcoidosis and then tuberculosis as the most common diagnosis.…”