Endobronchial Ultrasound-Transbronchial Needle Aspiration of Mediastinal and Hilar Lymphadenopathy Learning Curve.
Endobronchial Ultrasound-Transbronchial Needle Aspiration of Mediastinal and Hilar Lymphadenopathy Learning Curve.
复制标题
支气管内超声-纵隔和肺门淋巴结病经支气管针吸活检学习曲线。
DOI：
10.1097/mjt.0000000000000050
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发表时间：
2016
影响因子：
4.2
通讯作者：
Palomino,Jaime
中科院分区：
文献类型：
--
作者：
Kheir,Fayez;Alokla,Khalid;Myers,Leann;Palomino,Jaime
支气管内超声(EBUS)-经支气管穿刺（TBNA）已成为一种广泛使用的工具，与金标准程序（纵隔镜检查）相比，可以对纵隔和肺门淋巴结进行取样，其准确性相当。本研究的目的是评估该技术在学术医疗中心对恶性疾病患者和非恶性疾病患者的能力和准确性。这是对前150例在我院接受EBUS-TBNA的患者的回顾性图表回顾，这些患者在执行手术时没有接受过培训或监督。所有非诊断性结果均通过纵隔镜检查证实。累积和分析是一种用于根据既定标准持续监测绩效的方法，以获得所执行程序的能力。采用累积和法评估学习曲线。程序分为六分位（1-25、26-50、51-75、76-100、101-125和126-150）。采用Cochran-Armitage趋势检验，计算该技术对6个类别的诊断准确率，并评估准确率提高的趋势。操作者的能力在第55到60个程序之间达到。诊断准确率从72%增加到88%（从第一个六分位数到第三个六分位数），但之后保持稳定在88%（CA趋势检验P= 0.091）。总体诊断准确率为84%。学员在获得足够知识的情况下，学习率是不同的。我们建议在医生在没有监督的情况下执行EBUS-TBNA程序之前，使用每个操作员的学习曲线来评估其能力。
Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) has become a widely available tool that allows sampling of mediastinal and hilar lymph nodes with comparable accuracy as compared with the gold standard procedure, mediastinoscopy. The goal of this study was to evaluate the competence accuracy of this technique in academic medical center in patients with and without malignant disease. This was a retrospective chart review of the first 150 patients who underwent EBUS-TBNA at our institution with an operator not previously trained or supervised while performing the procedure. All nondiagnostic results were confirmed with mediastinoscopy. The cumulative sum analysis is a method used to continuously monitor performance against an established standard to attain competence in the procedure performed. Learning curve was assessed using cumulative sum method. Procedures were divided into sextiles (1–25, 26–50, 51–75, 76–100, 101–125, and 126–150). The technique's diagnostic accuracy was calculated for each of the 6 categories and trend toward improved accuracy was assessed using Cochran–Armitage trend test. Operator competency was achieved between 55th and 60th procedures. The diagnostic accuracy increased from 72% to 88%(from the first to third sextile) but remained stable afterwards at 88%(CA trend test P= 0.091). The overall diagnostic accuracy was 84%. Trainees' learning rate varies while acquiring adequate knowledge. We suggest that a learning curve for each operator be used to assess competence in EBUS-TBNA procedure before physicians perform it without supervision.