title: Learning curve of conventional transbronchial needle aspiration in pulmonologists experienced in bronchoscopy.
abstract: BACKGROUND
  Despite its proven efficacy, transbronchial needle aspiration (TBNA) remains an underutilized technique for sampling enlarged mediastinal lymph nodes in the staging of lung cancer. Previous investigators have reported on TBNA experience, but without mentioning individual learning curves related to lymph node size in pulmonologists experienced in bronchoscopy.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the TBNA learning curve in a group of pulmonologists already experienced in bronchoscopy, and to relate their yields to lymph node size and location.
  
  
  METHODS
  Data on TBNA yield and related lymph node size were collected retrospectively for five individual pulmonologists.
  
  
  RESULTS
  The diagnostic yield of five pulmonologists who started to perform TBNA was evaluated over the first 32 months. TBNA was performed on 138 lymph nodes in 119 patients. The overall diagnostic yield was 77% (range 67-91%). The average diagnostic yield increased from 77% at the start of the learning curve to 82% after 32 months of experience. It was related to lymph node size, but not to lymph node location. The average lymph node size was 22 mm.
  
  
  CONCLUSIONS
  Satisfactory results were obtained immediately after introduction of TBNA in the bronchoscopy workup. There is no significant TBNA learning curve. The diagnostic yield was related to lymph node size but not to lymph node location.
authors.affiliation: Department of Pulmonary Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Frank H W
authors.initials: FH
authors.lastname: Hermens
authors.forename: Gijs J M
authors.initials: GJ
authors.lastname: Limonard
authors.forename: René
authors.initials: R
authors.lastname: Termeer
authors.forename: Willem
authors.initials: W
authors.lastname: van den Berg
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Visser
authors.forename: Bernard E A
authors.initials: BE
authors.lastname: Hol
authors.forename: Julius P
authors.initials: JP
authors.lastname: Janssen
mesh_terms: D001707:Biopsy, Needle / Q000379:methods / Q000592:standards*; D001999:Bronchoscopy / Q000592:standards*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D015272:Pulmonary Medicine / Q000193:education*