Initial experience with endobronchial ultrasound in an academic thoracic surgery program

Area of Science:

• Pulmonology
• Thoracic Surgery
• Interventional Pulmonology

Background:

• Mediastinoscopy is the standard for mediastinal lymph node evaluation.
• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a less invasive alternative.
• Literature suggests an initial learning curve for EBUS-TBNA.

Purpose of the Study:

• To present the initial experience of 4 thoracic surgeons with EBUS-TBNA.
• To assess the learning curve and diagnostic performance of EBUS-TBNA.
• To evaluate the safety and accuracy of EBUS-TBNA in mediastinal lymph node assessment.

Main Methods:

• Retrospective chart review of the first 51 EBUS-TBNA procedures.
• Inclusion of patients with malignancy or suspected sarcoidosis.
• Confirmation of negative results with mediastinoscopy.
• Assessment of technique sensitivity, specificity, and accuracy.

Main Results:

• 73 lymph nodes biopsied in 51 patients (34 male, 17 female; average age 62).
• No surgical or postoperative complications reported.
• Overall diagnostic accuracy of 88% (45/51 patients).
• Improved diagnostic yield after technique modification: sensitivity increased from 72.22% to 95.45%, accuracy from 80% to 96.15%.

Conclusions:

• EBUS-TBNA is a quickly mastered technique.
• It provides a safe, minimally invasive, and accurate method for mediastinal lymph node evaluation.
• The procedure demonstrates a rapid improvement in performance with experience.