title: Endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymphadenopathy: effect of the learning curve.
abstract: This study aimed to evaluate the learning curve and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the examination of mediastinal or hilar lymph nodes suspected of having cancer or of benign disease such as sarcoidosis. A success-adjusted cumulative sum model was used to evaluate the learning curve for diagnostic rates and operation time. A total of 99 patients (77 men and 22 women) who underwent EBUS-TBNA from April 2011 to March 2012 in a single centre were analysed retrospectively. The quantity of lymph node sampling was deemed to be appropriate for histopathological examination in 97 of 99 patients (97%). Twenty-three cases (23%) were clearly diagnosed with neoplastic disease, 60 (60%) with reactive hyperplasia, 11 (11%) with granulomatosis and 3 (3%) histopathologically suspicious for lymph node metastasis. The sensitivity, specificity, and positive and negative predictive values and diagnostic accuracy for EBUS-TBNA were 80, 100, 100, 87.1 and 91.5%, respectively. According to the learning curve analysis, the ability to perform EBUS required performing approximately 37 procedures for the trials. In conclusion, more successful results are obtained after a certain learning curve, as is the case for every other invasive procedure.
authors.affiliation: Department of Thoracic Surgery, Dr Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Izmir, Turkey ozanusluer@yahoo.com.
authors.forename: Ozan
authors.initials: O
authors.lastname: Usluer
authors.affiliation: Department of Thoracic Surgery, Dr Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Izmir, Turkey.
authors.forename: Seyda Ors
authors.initials: SO
authors.lastname: Kaya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002983:Clinical Competence; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D059032:Learning Curve; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014421:Turkey
keywords: Endobronchial ultrasound-guided transbronchial needle aspiration; Lung cancer; Lymph node metastasis; Lymphadenopathy; Staging