Fuso Leonello, Varone Francesco, Magnini Daniele, Pecoriello Antonietta, Montemurro Giuliano, Angeletti Giulia, Valente Salvatore
*Bronchoscopy †Pneumology Unit, Catholic University, Rome ‡Respiratory Medicine and Intensive Care Unit, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
J Bronchology Interv Pulmonol. 2017 Jul;24(3):193-199. doi: 10.1097/LBR.0000000000000372.
The diagnostic yield of conventional transbronchial needle aspiration (TBNA) is characterized by a learning effect. The aim of this retrospective study was to verify whether a learning curve similarly affected the yield of endobronchial ultrasound-guided (EBUS)-TBNA. To this end, we evaluated the sensitivity and diagnostic accuracy of EBUS-TBNA during the first 3 years of activity.
EBUS-TBNA was performed by 2 operators with no previous experience in this technique. Cytologic samples were obtained from mediastinal and hilar lymph nodes enlarged at a chest computed tomography scan and/or with increased fluorodeoxyglucose uptake at computed tomography/positron emission tomography scan in patients with suspected lung cancer. The cytologic diagnosis of EBUS-TBNA samples has been compared with the final diagnosis obtained from further diagnostic procedures, surgery, or clinical-radiologic follow-up.
From October 2012 to October 2015, we collected 408 EBUS-TBNA cytologic samples from 313 patients: 223 samples were positive for metastatic involvement and 185 were nonmetastatic. The latter included 137 true-negative and 48 false-negative results. The final diagnosis comprised 271 metastatic and 137 nonmetastatic lymph nodes. The overall sensitivity for cancer was 82% and diagnostic accuracy was 88%. Sensitivity and accuracy per year were as follows: first year, 78% and 82% in 90 nodal samples; second year, 83% and 89% in 144 nodal samples; third year, 85% and 91% in 174 nodal samples.
EBUS-TBNA can be considered as a reliable tool even if performed by operators without previous experience in this procedure, and the diagnostic yield continues to increase progressively over a long time.
传统经支气管针吸活检术（TBNA）的诊断阳性率存在学习效应。这项回顾性研究的目的是验证学习曲线是否同样影响超声支气管镜引导下（EBUS）-TBNA的阳性率。为此，我们评估了EBUS-TBNA在开展的前3年中的敏感性和诊断准确性。
由2名此前无该技术经验的操作者进行EBUS-TBNA。对疑似肺癌患者胸部计算机断层扫描显示纵隔和肺门淋巴结肿大及/或在计算机断层扫描/正电子发射断层扫描中氟脱氧葡萄糖摄取增加的部位获取细胞学样本。将EBUS-TBNA样本的细胞学诊断与通过进一步诊断程序、手术或临床-放射学随访获得的最终诊断进行比较。
2012年10月至2015年10月，我们从313例患者中收集了408份EBUS-TBNA细胞学样本：223份样本转移性受累呈阳性，185份为非转移性。后者包括137例真阴性和48例假阴性结果。最终诊断包括271个转移性淋巴结和137个非转移性淋巴结。癌症总体敏感性为82%，诊断准确性为88%。每年的敏感性和准确性如下：第一年，90个淋巴结样本中分别为78%和82%；第二年，144个淋巴结样本中分别为83%和89%；第三年，174个淋巴结样本中分别为85%和91%。
即使由此前无该操作经验的操作者进行EBUS-TBNA，也可将其视为一种可靠的工具，并且诊断阳性率在很长一段时间内持续逐步提高。
