Department of Respiratory Medicine and Thoracic Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada.
Division of Respiratory Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Thorac Cancer. 2017 Sep;8(5):517-522. doi: 10.1111/1759-7714.12481. Epub 2017 Jul 21.
Linear endobronchial ultrasound (EBUS) is a safe and effective method for the diagnostic sampling of mediastinal lymph nodes. However, there is a learning curve associated with the procedure and operator experience influences diagnostic yield. We sought to determine if trainee involvement during EBUS influences procedural characteristics, complication rate, and diagnostic yield.
We performed a retrospective analysis of 220 subjects who underwent an EBUS procedure at our center from December 2012 to June 2013. Procedures were performed by six different interventional pulmonologists with substantial experience with EBUS or by a trainee under their direct supervision. Procedural characteristics and complications were recorded. Diagnostic yield and specimen adequacy were compared between groups.
EBUS was performed in 220 patients with a trainee involved (n = 116) or by staff physician alone (n = 104). Patient characteristics, and the number and size of lymph node stations sampled were similar. EBUS duration was longer (16.0 vs. 13.7 minutes; P = 0.002) and the total dose of lidocaine used was higher (322.3 vs. 304.2 mg; P = 0.045) when a trainee was involved. The rate of adequate specimens sampled was comparable between the groups (92.0 vs. 92.0%; P = 0.60). Diagnostic yield was lower when a trainee was involved in the EBUS procedure (52.6 vs. 68.3%; P = 0.02).
Trainee involvement significantly increased EBUS duration and the dose of local anesthesia used for the procedure. Diagnostic yield was lower when a trainee was involved. Factors accounting for this difference in yield, despite adequate samples being obtained, warrant further investigation.
线性支气管内超声（EBUS）是一种安全有效的纵隔淋巴结诊断取样方法。然而，该操作存在学习曲线，操作者的经验会影响诊断率。我们旨在确定在 EBUS 过程中是否有学员参与会影响操作特点、并发症发生率和诊断率。
我们对 2012 年 12 月至 2013 年 6 月在我们中心进行的 220 例 EBUS 手术进行了回顾性分析。这些手术由 6 名具有丰富 EBUS 经验的介入肺科医生或在他们直接监督下的学员进行。记录了操作特点和并发症。比较了两组之间的诊断率和标本充分性。
在 220 例患者中，有 116 例有学员参与（n=116），104 例由主治医生单独操作（n=104）。患者的特征、采样的淋巴结站的数量和大小相似。当有学员参与时，EBUS 持续时间更长（16.0 分钟对 13.7 分钟；P=0.002），使用的利多卡因总量更高（322.3 毫克对 304.2 毫克；P=0.045）。两组采样的标本充分率相似（92.0%对 92.0%；P=0.60）。当有学员参与 EBUS 操作时，诊断率较低（52.6%对 68.3%；P=0.02）。
学员参与显著增加了 EBUS 持续时间和操作中使用的局部麻醉剂量。当有学员参与时，诊断率较低。尽管获得了足够的样本，但导致这种产量差异的因素需要进一步调查。
