Department of Pulmonary, Baskent University School of Medicine, Ankara, Turkey.
Department of Pathology, Baskent University School of Medicine, Ankara, Turkey.
Ann Thorac Med. 2015 Jan-Mar;10(1):50-4. doi: 10.4103/1817-1737.146873.
Conventional transbronchial needle aspiration (C-TBNA) is a minimally invasive, safe, and cost-effective technique in evaluating mediastinal lymphadenopathy. Previously we reported that the skills for C-TBNA can be acquired from the books. We studied the learning curve for C-TBNA for a single bronchoscopist at a tertiary-care center where ultrasound technology remains difficult to acquire .
We prospectively collected results of the first 99 consecutively performed C-TBNA between December 2009 and 2013. Patients were divided into 3 groups: (I): First 33, (II): Next 33 and (III): Last 33. Results were categorized as malignant, non-malignant or non-diagnostic. Diagnostic yield (DY), sensitivity (SEN), specificity (SPE), positive and negative predictive values (PPV, NPV), and accuracy (ACC) were calculated to learn the learning curve for C-TBNA.
Total 99 patients (M:F = 62:37), mean age 58.2 ± 11.5 years, mean LN diameter 26.9 ± 9.8 mm underwent C-TBNA. Sixty-nine patients had lymph nodes (LNs) >20 mm in diameter. Final diagnoses were established by C-TBNA in 44 (yield 44.4%), mediastinoscopy 47, transthoracic needle aspiration 5, endobronchial biopsy 2 and peripheral LN biopsy 1. C-TBNA was exclusively diagnostic in 35.4%. Group I: DY: 42.4%, 64.7% in malignancies, 19% in benign conditions (P = 0.008). SEN, SPE, PPV, NPV, ACC = 70%, 100%, 100%, 66.6%, 78.7%, respectively. Group II: DY: 54.5% (36.4% exclusive), 88.2% in malignancies and 19% benign conditions (P = 0.000). SEN, SPE, PPV, NPV, ACC=72%, 100%, 100%, 53.3%, 78.7%, respectively. Group III: DY: 36.3% (27% exclusive), 100% in malignancies and 16% in benign conditions. SEN, SPE, PPV, NPV, ACC = 92.3%, 100%, 100%, 95.2%, 97%, respectively. No difference was found in relation to LN size or location and TBNA yield.
C-TBNA can be easily learned and the proficiency can be attained with <66 procedures. In selected patients, its exclusivity could exceed 35%.
传统经支气管针吸活检术（C-TBNA）是一种微创、安全且具有成本效益的技术，可用于评估纵隔淋巴结病。我们曾报道过，C-TBNA 技术可以通过书籍来掌握。我们研究了在一家三级保健中心，在那里超声技术仍然难以获得的情况下，单个支气管镜医师的 C-TBNA 学习曲线。
我们前瞻性地收集了 2009 年 12 月至 2013 年间连续进行的 99 例 C-TBNA 的结果。患者被分为 3 组：（I）：前 33 例；（II）：接下来的 33 例；（III）：最后 33 例。结果分为恶性、非恶性或非诊断性。计算诊断率（DY）、敏感性（SEN）、特异性（SPE）、阳性和阴性预测值（PPV、NPV）和准确性（ACC），以了解 C-TBNA 的学习曲线。
共有 99 例患者（男：女=62：37），平均年龄 58.2±11.5 岁，平均淋巴结直径 26.9±9.8mm 接受 C-TBNA。69 例患者的淋巴结直径>20mm。C-TBNA 最终诊断出 44 例（44.4%），纵隔镜检查 47 例，经胸针吸活检 5 例，支气管内活检 2 例，外周淋巴结活检 1 例。C-TBNA 完全诊断的比例为 35.4%。组 I：DY：42.4%，恶性肿瘤 64.7%，良性疾病 19%（P=0.008）。SEN、SPE、PPV、NPV、ACC 分别为 70%、100%、100%、66.6%、78.7%。组 II：DY：54.5%（36.4%为独占性），恶性肿瘤 88.2%，良性疾病 19%（P=0.000）。SEN、SPE、PPV、NPV、ACC 分别为 72%、100%、100%、53.3%、78.7%。组 III：DY：36.3%（27%为独占性），恶性肿瘤 100%，良性疾病 16%。SEN、SPE、PPV、NPV、ACC 分别为 92.3%、100%、100%、95.2%、97%。淋巴结大小或位置与 TBNA 产量之间无差异。
C-TBNA 易于学习，掌握<66 例即可达到熟练程度。在选定的患者中，其独占性可能超过 35%。
