Ong Alvin Shao Qiang, Tan Aik Hau, Anantham Devanand, Sharma Kiran, Tan Shera, Lapperre Therese Sophie, Tham Kah Yee, Sultana Rehena, Koh Mariko Siyue
Duke-National University of Singapore Medical School, Singapore.
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
J Thorac Dis. 2018 Sep;10(9):5621-5635. doi: 10.21037/jtd.2018.08.76.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic yield and low complication rate. Whilst it has been included in international guidelines for the diagnosis and staging of lung cancer, current results are mostly based on EBUS experts performing EBUS-TBNA in centres of excellence. The impact of simulation training on diagnostic yield, complications, scope damage and repair cost in a real-world teaching hospital is unclear.
A review of our hospital EBUS-TBNA registry from August 2008 to December 2016 was performed. A positive diagnosis was defined as a confirmed histological or microbiological diagnosis based on EBUS sampling. Complications were classified as major or minor according to the British Thoracic Society guidelines. In addition, we assessed the cost of repairs for scope damage before and after simulation training was implemented. Using CUSUM analysis, the learning curves of individual trainees and the institution were plotted.
There were 608 EBUS-TBNA procedures included in the study. The number of procedures performed by trainees who underwent conventional training was 331 and those who underwent simulation training performed 277 procedures. Diagnostic yield for trainees without simulation training was 88.2% 84.5% for trainees with simulation training (P=0.179). There was no statistical difference in the diagnostic yield between the groups of trainees (OR: 0.781, 95% CI: 0.418-1.460, P=0.438) after adjusting for risk factors. There was an increase in overall complications from 13.6% to 16.6% (OR: 2.247, 95% CI: 1.297-3.891, P=0.004) after introduction of the simulation training, but a trend to decrease in major complications 3.6% to 0.7% (P=0.112). The cost for scope repairs for the trainees without simulation training was SGD 413.88 per procedure SGD 182.79 per procedure for the trainees with simulation training, with the mean difference being SGD 231.09 per procedure (95% CI: 178.40-640.60, P=0.268). CUSUM analysis showed an increasing learning curve for the trainees with simulation training after an initial competency period.
There was no statistical difference in diagnostic yield from EBUS-TBNA and cost of scope damage after simulation training was introduced into our training program. Interestingly, there was an increase in minor complications. CUSUM analysis can provide additional information on institutional learning curves. The value of simulation training in EBUS-TBNA remains uncertain.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）具有较高的诊断率和较低的并发症发生率。虽然它已被纳入肺癌诊断和分期的国际指南，但目前的结果大多基于EBUS专家在卓越中心进行EBUS-TBNA。模拟培训对实际教学医院的诊断率、并发症、内镜损坏及维修成本的影响尚不清楚。
对我院2008年8月至2016年12月的EBUS-TBNA登记资料进行回顾性分析。阳性诊断定义为基于EBUS采样确诊的组织学或微生物学诊断。根据英国胸科学会指南，将并发症分为严重或轻微。此外，我们评估了实施模拟培训前后内镜损坏的维修成本。使用累积和分析（CUSUM分析）绘制个体学员和机构的学习曲线。
本研究共纳入608例EBUS-TBNA操作。接受传统培训的学员进行了331例操作，接受模拟培训的学员进行了277例操作。未接受模拟培训的学员诊断率为88.2%，接受模拟培训的学员诊断率为84.5%（P = 0.179）。调整风险因素后，两组学员的诊断率无统计学差异（OR：0.781，95%CI：0.418 - 1.460，P = 0.438）。引入模拟培训后，总体并发症从13.6%增加到16.6%（OR：2.247，95%CI：1.297 - 3.891，P = 0.004），但严重并发症有下降趋势，从3.6%降至0.7%（P = 0.112）。未接受模拟培训的学员每次操作的内镜维修成本为413.88新元，接受模拟培训的学员为182.79新元，平均差异为每次操作231.09新元（95%CI：178.40 - 640.60，P = 0.268）。CUSUM分析显示，经过初始胜任期后，接受模拟培训的学员学习曲线呈上升趋势。
在我们的培训计划中引入模拟培训后，EBUS-TBNA的诊断率和内镜损坏成本无统计学差异。有趣的是，轻微并发症有所增加。CUSUM分析可以提供关于机构学习曲线的额外信息。EBUS-TBNA中模拟培训的价值仍不确定。
