title: Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.
abstract: BACKGROUND
  Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians.
  
  
  METHODS
  Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion.
  
  
  RESULTS
  Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement.
  
  
  CONCLUSIONS
  Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.
authors.affiliation: Duke University Medical Center, Division of Pulmonary and Critical Care Medicine, Durham, NC. Electronic address: momen.wahidi@duke.edu.
authors.forename: Momen M
authors.initials: MM
authors.lastname: Wahidi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Herth
authors.affiliation: Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Ray Wesley
authors.initials: RW
authors.lastname: Shepherd
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.affiliation: Division of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mohit
authors.initials: M
authors.lastname: Chawla
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Lahey Clinic Hospital, Burlington, MA.
authors.forename: Carla
authors.initials: C
authors.lastname: Lamb
authors.affiliation: Division of Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Casey
authors.affiliation: CHEST, Glenview, IL.
authors.forename: Sheena
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Silvestri
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: David J
authors.initials: DJ
authors.lastname: Feller-Kopman
mesh_terms: D001999:Bronchoscopy / Q000193:education / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis*; D002983:Clinical Competence; D016292:Procedural Sedation; D054810:Deep Sedation; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008206:Lymphatic Diseases / Q000175:diagnosis; D008223:Lymphoma / Q000175:diagnosis*; D008479:Mediastinal Neoplasms / Q000175:diagnosis*; D009339:Needles; D015272:Pulmonary Medicine; D012507:Sarcoidosis / Q000175:diagnosis*; D000066908:Simulation Training; D012955:Societies, Medical
keywords: endobronchial ultrasound; evidence-based medicine; guidelines; transbronchial needle aspiration