Nakamura Midori, Uchimura Keigo, Hara Sachika, Ohira Hidenori, Chiba Yosuke, Nemoto Kazuki, Higashi Yasuyuki, Tahara Masahiro, Ikegami Hiroaki, Hirano Yoko, Sakagami Kazuki, Uyama Kazuhiro, Sennari Konomi, Tachiwada Takashi, Kawabata Hiroki, Noguchi Shingo, Yamasaki Kei, Kawanami Toshinori, Yatera Kazuhiro
Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.
J UOEH. 2019;41(2):179-184. doi: 10.7888/juoeh.41.179.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in Japan. The guidelines of the American College of Chest Physicians has recommended that EBUS-TBNA should be performed by well-trained operators who can perform highly accurate procedures, but the indicators of the degree of experience and training are unclear. In our department, physicians who do not have enough experience perform EBUS-TBNA under the supervision of bronchoscopic instructors who have EBUS-TBNA techniques (Board Certified Member of the Japan Society for Respiratory Endoscopy) after guidance and training in EBUS-TBNA using a simulator as an operator and helper. In order to evaluate the influence of the experience and training of EBUS-TBNA on diagnostic accuracy and safety, we retrospectively compared the diagnostic accuracy and safety of EBUS-TBNA performed by physicians within one year of experience of EBUS-TBNA and those performed by physicians with more than one year of experience. A total of 111 cases (148 lesions) who were eventually diagnosed as having primary lung cancer and underwent EBUS-TBNA in our department between April 2014 and January 2016 were divided into two groups. Group A (43 cases, 57 lesions) was examined by third-year doctors within one year of experience of EBUS-TBNA, and group B (68 cases, 91 lesions) was examined by doctors with four or more years of experience and with more than one year of experience of EBUS-TBNA. Diagnostic rate, examination time, and complications were evaluated. There were no significant differences between the two groups in the diagnostic rate (A, 89.5% vs. B, 90.1%, P = 1.0) or examination time (A, 27 min vs. B, 23 min, P = 0.149), and no complications were observed in either group. This study suggests that even less-experienced physicians may safely perform EBUS-TBNA as well as moderately-experienced physicians with more than 1 year experience of EBUS-TBNA with similar diagnostic rates when proper training and supervision are supplied.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在日本已被广泛应用。美国胸科医师学会的指南建议，EBUS-TBNA应由训练有素、能进行高度精确操作的操作人员来实施，但经验和培训程度的指标尚不清楚。在我们科室，经验不足的医生在使用模拟器作为操作者和助手接受EBUS-TBNA的指导和培训后，在具备EBUS-TBNA技术的支气管镜指导教师（日本呼吸内镜学会认证会员）的监督下进行EBUS-TBNA。为了评估EBUS-TBNA的经验和培训对诊断准确性和安全性的影响，我们回顾性比较了EBUS-TBNA经验不足一年的医生与经验超过一年的医生所实施的EBUS-TBNA的诊断准确性和安全性。2014年4月至2016年1月期间，我们科室共有111例最终被诊断为原发性肺癌并接受EBUS-TBNA的患者（148个病灶）被分为两组。A组（43例，57个病灶）由EBUS-TBNA经验不足一年的三年级医生检查，B组（68例，91个病灶）由有四年或四年以上经验且EBUS-TBNA经验超过一年的医生检查。评估诊断率、检查时间和并发症。两组在诊断率（A组89.5% vs. B组90.1%，P = 1.0）或检查时间（A组27分钟 vs. B组23分钟，P = 0.149）方面无显著差异，且两组均未观察到并发症。这项研究表明，当提供适当的培训和监督时，经验较少的医生与有超过一年EBUS-TBNA经验的经验适度的医生一样，可能安全地进行EBUS-TBNA，且诊断率相似。
