Chest
Volume 112, Issue 1, July 1997, Pages 251-253
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Special Report: Articles
Underutilization of Transbronchial Needle Aspiration: Experiences of Current Pulmonary Fellows

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Transbronchial needle aspiration (TBNA) is a valuable, minimally invasive procedure for diagnosing and staging lung cancer in patients, but it is underutilized by practicing pulmonologists. To assess the approach to TBNA of current pulmonary Fellows, we recorded their computerized interactive responses during the 1995 American College of Chest Physicians Fellows' Conference. Among 109 Fellows attending, only 10% reported that they routinely (≥85% of cases) performed TBNA to diagnose or stage malignant disease, and 40% noted that they rarely (≤5% of cases) performed it. They estimated their diagnostic TBNA yields in patients with mediastinal cancer as follows: ≥80% by 2% of Fellows; between 25% and 80% by 54% of Fellows; and <25% by 45% of Fellows. They noted that the main limitations of TBNA at their institutions were suboptimal bronchoscopy technique (30%), technician support (1%), cytopathology support (14%), all of these factors (25%), or the belief that TBNA is not useful (30%). TBNA is currently underutilized and/or underemphasized at bronchoscopy training programs. Major modifications of Fellow experiences are necessary if TBNA is to impact optimally on patient management.

Section snippets

Materials and Methods

We recorded the computerized responses of pulmonary Fellows attending a presentation about TBNA at an interactive Fellows' Conference sponsored by the American College of Chest Physicians in October 1995, and noted the frequencies of their answers to the following multiple choice questions:

  • 1.

    How often do you perform TBNA in diagnosing or staging malignant disease?

    • 1.

      Routinely (≫85% of cases)

    • 2.

      Often (50-84% of cases)

    • 3.

      Sometimes (6-49% of cases)

    • 4.

      Rarely (≫5% of cases)

  • 2.

    In patients with

Results

Interactive responses were recorded from 109 Fellows. Their estimates of the frequencies with which they performed TBNA in patients with malignant disease are summarized in Figures 1 and 2. Only 10% reported that they routinely performed TBNA to diagnose or stage malignant disease, and 40% noted that they rarely performed it. Their estimates of diagnostic yields (Fig 2) varied considerably, but approximately half reported yield ≥25%.

Fellows' perspectives of the main limitations of TBNA are

Discussion

Despite numerous limitations related to selection bias, possible inaccurate recollections of their own TBNA experience, and other factors, we believe that the overall views of Fellows about their TBNA experiences provide worthwhile information that should prompt concerns about the breadth of the bronchoscopy training that they receive. TBNA is currently underutilized and/or underemphasized at bronchoscopy training programs. The similarity of these Fellows' estimates of the frequency of TBNA

ACKNOWLEDGMENTS

The writers thanks Renata Simonsen and the ACCP for the superb coordination of the conference and for facilitating data collection, and Maxine Davis for secretarial assistance.

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revision accepted December 5.

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