title: Learning endobronchial ultrasound transbronchial needle aspiration - a 6-year experience at a single institution.
abstract: BACKGROUND
  Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has become an important diagnostic tool for the pulmonologist. Learning this procedure and maintaining technical skills requires continuous practice and evaluation.
  
  
  OBJECTIVE
  The aims of the study were a retrospective evaluation of the diagnostic quality of the EBUS-technique and the learning profile of the endoscopy team during the first years (2007-2013) of experience in an unselected population.
  
  
  METHODS
  EBUS-TBNA procedures were analysed for clinical data, including results from surgery or clinical/radiological follow-up for at least 6 months. Rapid on-site cytological evaluation (ROSE) was introduced on regular basis the forth year.
  
  
  RESULTS
  A total of 711 EBUS-TBNA from 635 patients were included. The percentage of representative EBUS-TBNA initially decreased the first years (minimum 60,9%), before increased to a final result of 82,4%. There was a lower proportion of representative EBUS-TBNA in the benign group (76,8%) vs the malignant group (85,8%). A significant increase in the proportion of representative EBUS-TBNA was seen after ROSE had been introduced. The major indications were diagnosing/staging of lung cancer (54%) and mediastinal lymphadenopathy of unknown cause (25,7%). The sensitivity detecting malignancy was 94,9%, negative predictive value 81,2% and diagnostic accuracy 95,8%. During the study period the percentage of re-examinations with EBUS-TBNA declined from 18,0% to 8,2%.
  
  
  CONCLUSIONS
  After an initial run-in period with declining results, the overall diagnostic yield of EBUS-TBNA increased and reached acceptable levels. These results underline the importance of continuously evaluation of our own results when new methods are implemented in clinical practice.
authors.affiliation: Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Sveinung
authors.initials: S
authors.lastname: Sørhaug
authors.affiliation: Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Hjelde
authors.affiliation: Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Peter
authors.initials: P
authors.lastname: Hatlen
authors.affiliation: Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Håkon Olav
authors.initials: HO
authors.lastname: Leira
authors.affiliation: Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Majid
authors.initials: M
authors.lastname: Salarinejad
authors.affiliation: Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Bjarte
authors.initials: B
authors.lastname: Nesvik
authors.affiliation: Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Raymond
authors.initials: R
authors.lastname: Hollund
authors.affiliation: Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Kristin
authors.initials: K
authors.lastname: Nesgård
authors.affiliation: Department of Thoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Dag Ole
authors.initials: DO
authors.lastname: Nordhaug
authors.affiliation: Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Tore
authors.initials: T
authors.lastname: Amundsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi; D002648:Child; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007858:Learning; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015272:Pulmonary Medicine / Q000193:education*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: bronchoscopy; endobronchial ultrasound; lung cancer; sarcoidosis