Conventional transbronchial needle aspiration: From acquisition to precision

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Procedures

Background:

• Conventional transbronchial needle aspiration (C-TBNA) is a safe and cost-effective method for evaluating mediastinal lymphadenopathy.
• Acquiring C-TBNA skills can be achieved through training and practice.
• This study investigates the learning curve of C-TBNA for a single bronchoscopist in a resource-limited setting.

Purpose of the Study:

• To assess the learning curve and proficiency development for conventional transbronchial needle aspiration (C-TBNA).
• To determine the diagnostic yield, sensitivity, specificity, and accuracy of C-TBNA over time.
• To evaluate the efficacy of C-TBNA in diagnosing mediastinal lymphadenopathy.

Main Methods:

• Prospective collection of data from the first 99 C-TBNA procedures performed by a single bronchoscopist.
• Patients were divided into three groups (33 each) to analyze performance changes.
• Diagnostic yield (DY), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) were calculated.

Main Results:

• The overall diagnostic yield of C-TBNA was 44.4%, with exclusive diagnostic success in 35.4% of cases.
• Diagnostic yield and accuracy improved across the learning groups, with the third group showing the highest accuracy (97%).
• Sensitivity and specificity remained high throughout, with the final group achieving 92.3% sensitivity and 100% specificity.

Conclusions:

• Proficiency in C-TBNA can be achieved with fewer than 66 procedures.
• C-TBNA is a valuable tool for diagnosing mediastinal lymphadenopathy, with potential for high diagnostic exclusivity in selected cases.
• The technique is easily learned and demonstrates increasing efficacy with experience.