Learning endobronchial ultrasound transbronchial needle aspiration - a 6-year experience at a single institution
Learning endobronchial ultrasound transbronchial needle aspiration - a 6-year experience at a single institution
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DOI：
10.1111/crj.12475
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发表时间：
2018-01-01
影响因子：
1.7
通讯作者：
Amundsen, Tore
中科院分区：
文献类型：
--
作者：
Sorhaug, Sveinung;Hjelde, Harald;Amundsen, Tore
简介：经支气管针吸支气管内超声检查（EBUS-TBNA）已成为肺科医生的重要诊断工具。学习这一程序和保持技术技能需要不断的实践和evaluation.Objectives：本研究的目的是回顾性评价EBUS技术的诊断质量和内窥镜团队在最初几年的学习概况（2007-2013年）的经验，在一个人口普查。对EBUS-TBNA手术的临床数据进行了分析，包括至少6个月的手术或临床/放射学随访结果。结果：共纳入635例患者的711例EBUS-TBNA。代表性EBUS-TBNA的百分比最初在第一年下降（最低60.9%），然后增加到82.4%的最终结果。良性组中代表性EBUS-TBNA的比例（76.8%）低于恶性组（85.8%）。ROSE引入后，代表性EBUS-TBNA的比例显著增加。主要指征为肺癌的诊断/分期（54%）和原因不明的纵隔淋巴结病（25.7%）。诊断恶性肿瘤的敏感性为94.9%，阴性预测值为81.2%，诊断准确性为95.8%。在研究期间，EBUS-TBNA的复查率从18.0%下降到8.2%。结论：EBUS-TBNA的总体诊断率在经历了最初的磨合期后有所提高，达到了可接受的水平。这些结果强调了在临床实践中实施新方法时不断评估我们自己的结果的重要性。
Introduction: 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.Objectives: 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%.Conclusion: 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.