title: Enhancement of conventional TBNA outcome after EBUS Training.
abstract: BACKGROUND
  Conventional transbronchial needle aspiration (C-TBNA) is a well-established technique for the diagnosis and staging of bronchogenic carcinoma. Because of the implementation of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), the C-TBNA is being used less frequently. Despite its proven diagnostic utility some of the pulmonary fellowship programs have chosen to eliminate training for C-TBNA from their curriculum. The objective our study was to compare the outcomes of C-TBNA before and after the implementation of EBUS in our unit.
  
  
  METHODS
  We compared the diagnostic performance of C-TBNA in 2 groups of non-small cell lung cancer patients with mediastinal lymph nodes >10 mm in short axis as seen on the computed tomography scan of the chest. Patients underwent C-TBNA before (group A, N=147) or after (group B, N=67) implementing EBUS technology in our unit. C-TBNA technique was performed by the same bronchoscopists before and after being proficient in EBUS.
  
  
  RESULTS
  The overall accuracy in group B was higher than in group A (23.9% vs. 9.5%, respectively; P=0.0001). Overall test accuracy and sensitivity of C-TBNA was 66% versus 86% and 63% versus 86% in groups A and B, respectively. The negative predictive values of C-TBNA improved after EBUS training (19% vs. 33%, P<0.001). Inadequate samples were less frequent in group B than in group A (31.1% vs. 49.7%, respectively; P=0.00001).
  
  
  CONCLUSIONS
  Diagnostic performance of C-TBNA improves after EBUS training. C-TBNA should remain in the armamentarium of every bronchoscopist and on the curriculum of all pulmonary fellowship training programs even if EBUS technology is available.
authors.affiliation: *Interventional Pulmonology Unit †Cytopathology Unit, Pathology Department, Salamanca University Hospital, Salamanca, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Cordovilla
authors.forename: Aldo M
authors.initials: AM
authors.lastname: Torracchi
authors.forename: Ma Carmen
authors.initials: MC
authors.lastname: García-Macías
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000193:education / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; 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; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education*; D012680:Sensitivity and Specificity