Transbronchial needle aspiration "by the books"

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Procedures

Background:

• Formal training for advanced bronchoscopic procedures is primarily acquired during interventional pulmonology (IP) fellowships.
• Limited program sizes can restrict the dissemination of formal IP training.

Purpose of the Study:

• To evaluate the success of conventional transbronchial needle aspiration (C-TBNA) when performed by physicians lacking formal IP training.
• To assess the feasibility of learning C-TBNA from non-fellowship sources.

Main Methods:

• Physicians learned C-TBNA techniques from literature, videos, and hands-on courses using inanimate models.
• Conventional TBNA was performed using 21-gauge or 19-gauge needles on consecutive patients with undiagnosed mediastinal lymphadenopathy.

Main Results:

• Thirty-four patients underwent C-TBNA; 22 had nodes >20 mm. The overall diagnostic yield for C-TBNA was 41.1% (14/34), establishing final diagnoses in 11 malignancies and 3 sarcoidosis cases.
• C-TBNA showed higher yield for suspected malignancies (55%) versus benign conditions (21.4%). Diagnostic accuracy was 79.4% with 100% specificity and PPV.
• Nodal size significantly impacted outcomes (P = 0.000), while location did not (P = 0.33). No complications or scope damage were reported.

Conclusions:

• Conventional-TBNA is a learnable skill through self-study and practice on models, without requiring formal IP fellowship training.
• The diagnostic results achieved through this training method are comparable to those reported in existing literature.