Acquisition of endobronchial ultrasound bronchoscopy proficiency at a Canadian academic center

Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a diagnostic technique for assessing intrathoracic lymph nodes and masses. EBUS-TBNA skill is most commonly acquired through training in interventional pulmonology (IP) or thoracic surgery, but there is no consensus on what constitutes appropriate training. Kingston Health Sciences Centre (KHSC) is a Canadian tertiary care academic institution without a formal IP training program that introduced EBUS in 2014. We seek to describe the attainment of EBUS skill by assessing diagnostic performance and to describe acquisition of skill at this non-IP center.

Retrospective analysis of EBUS-TBNA procedures at KHSC since 2014 was conducted. We reviewed the first 70 EBUS procedures performed by each of 4 pulmonologists without prior EBUS training between 2014 and 2019 (n=280). Collected data included patient characteristics, indication for EBUS, number, size, and sites of sampled lymph nodes, and diagnostic yield based on pathology reports. Descriptive statistics were used to assess performance and skill acquisition.

The number of EBUS-TBNA procedures increased from 5.3/month in 2014 to 18.3/month in 2019 and 25.5/month in 2023. In the 1^st quartile of skill acquisition (n=17 EBUS per pulmonologist), mean diagnostic yield was 76.5% (range, 70.6-82.4%) compared with 93.4% in the 4^th quartile (n=19 EBUS per pulmonologist; range, 89.5-94.7%). Complications such as persistent hypoxemia and bleeding were rare, occurring in 1 (0.4%) and 2 (0.7%) cases, respectively.

Non-IP trained pulmonologists were able to safely acquire EBUS-TBNA skill at a Canadian academic tertiary care center with a diagnostic accuracy comparable with those reported in literature, within their first 70 cases.