title: Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry.
abstract: BACKGROUND
  New transbronchial needle aspiration (TBNA) technologies have been developed, but their clinical effectiveness and determinants of diagnostic yield have not been quantified. Prospective data are needed to determine risk-adjusted diagnostic yield.
  
  
  METHODS
  We prospectively enrolled patients undergoing TBNA of mediastinal lymph nodes in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) multicenter database and recorded clinical, procedural, and provider information. All clinical decisions, including type of TBNA used (conventional vs endobronchial ultrasound-guided), were made by the attending bronchoscopist. The primary outcome was obtaining a specific diagnosis.
  
  
  RESULTS
  We enrolled 891 patients at six hospitals. Most procedures (95%) were performed with ultrasound guidance. A specific diagnosis was made in 447 cases. Unadjusted diagnostic yields were 37% to 54% for different hospitals, with significant between-hospital heterogeneity (P = .0001). Diagnostic yield was associated with annual hospital TBNA volume (OR, 1.003; 95% CI, 1.000-1.006; P = .037), smoking (OR, 1.55; 95% CI, 1.02-2.34; P = .042), biopsy of more than two sites (OR, 0.57; 95% CI, 0.38-0.85; P = .015), lymph node size (reference > 1-2 cm, ≤ 1 cm: OR, 0.51; 95% CI, 0.34-0.77; P = .003; > 2-3 cm: OR, 2.49; 95% CI, 1.61-3.85; P < .001; and > 3 cm: OR, 3.61; 95% CI, 2.17-6.00; P < .001), and positive PET scan (OR, 3.12; 95% CI, 1.39-7.01; P = .018). Biopsy was performed on more and smaller nodes at high-volume hospitals (P < .0001).
  
  
  CONCLUSIONS
  To our knowledge, this is the first bronchoscopy study of risk-adjusted diagnostic yields on a hospital-level basis. High-volume hospitals were associated with high diagnostic yields. This study also demonstrates the value of procedural registries as a quality improvement tool. A larger number and variety of participating hospitals is needed to verify these results and to further investigate other determinants of diagnostic yield.
authors.affiliation: Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: dost@mdanderson.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
authors.affiliation: Department of Pulmonary and Critical Care, St. Elizabeth Medical Center, Caritas Christi Health Care, Brighton, MA.
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
authors.affiliation: Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: Department of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.affiliation: Chicago Chest Center, Elk Grove Village, IL.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kovitz
authors.affiliation: Thoraxklinik, Heidelberg, Germany.
authors.forename: Felix J F
authors.initials: FJF
authors.lastname: Herth
authors.affiliation: Department of Pulmonary and Critical Care, The Henry Ford Hospital, Detroit, MI.
authors.forename: Michael
authors.initials: M
authors.lastname: Simoff
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001999:Bronchoscopy / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity