title: Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: a single institution's early learning curve.
abstract: BACKGROUND
  The gold standard for mediastinal lymph node evaluation is mediastinoscopy, which is invasive and allows access to only a limited number of mediastinal lymph node (MLN) stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) is emerging as a useful, less invasive technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). We report our initial experience with this procedure.
  
  
  METHODS
  Using our prospectively maintained database, we performed a single-institution retrospective chart review. Our study group consisted of all patients at the University of Minnesota who underwent EBUS-FNA for evaluation of mediastinal lymphadenopathy or for thoracic malignancy staging from September 1, 2006, through December 15, 2007. To assess our learning curve, we plotted the cumulative sensitivity (%) and accuracy (%) of our EBUS-FNA results as a function of the number of procedures we performed.
  
  
  RESULTS
  During the study period, 100 patients underwent EBUS, 92 with FNA. Of these, 56 patients (34 women, 22 men; mean age, 60.4 +/- 13.7 years) met our inclusion criteria. We found no complications. After our first 10 procedures, the sensitivity of our EBUS-FNA results was 96.2%; accuracy was 97.8% (rates comparable with other large series in the literature).
  
  
  CONCLUSIONS
  We conclude that the learning curve for EBUS-FNA for thoracic surgeons is about 10 procedures.
authors.affiliation: Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Groth
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Michael A
authors.initials: MA
authors.lastname: Maddaus
authors.forename: Mariam
authors.initials: M
authors.lastname: Alsharif
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Andrade
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008482:Mediastinum; D009361:Neoplasm Invasiveness / Q000473:pathology; D011336:Probability; D012042:Registries; D012680:Sensitivity and Specificity