Original article
General thoracic
Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes: A Single Institution's Early Learning Curve

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.
https://doi.org/10.1016/j.athoracsur.2008.06.042Get rights and content

Background

The gold standard for mediastinal lymph node evaluation is mediastinoscopy, which is invasive and allows access to only a limited number of mediastinal lymph node (MLN) stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) is emerging as a useful, less invasive technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). We report our initial experience with this procedure.

Methods

Using our prospectively maintained database, we performed a single-institution retrospective chart review. Our study group consisted of all patients at the University of Minnesota who underwent EBUS-FNA for evaluation of mediastinal lymphadenopathy or for thoracic malignancy staging from September 1, 2006, through December 15, 2007. To assess our learning curve, we plotted the cumulative sensitivity (%) and accuracy (%) of our EBUS-FNA results as a function of the number of procedures we performed.

Results

During the study period, 100 patients underwent EBUS, 92 with FNA. Of these, 56 patients (34 women, 22 men; mean age, 60.4 ± 13.7 years) met our inclusion criteria. We found no complications. After our first 10 procedures, the sensitivity of our EBUS-FNA results was 96.2%; accuracy was 97.8% (rates comparable with other large series in the literature).

Conclusions

We conclude that the learning curve for EBUS-FNA for thoracic surgeons is about 10 procedures.

Section snippets

Patients

The Institutional Review Board of the University of Minnesota approved this retrospective review of our prospectively maintained database and waived the need to obtain informed consent for each patient. We studied the charts of all consecutive patients who underwent EBUS-FNA at our institution for evaluation of mediastinal lymphadenopathy or staging of thoracic malignancy from September 1, 2006 (when we first performed EBUS-FNA), through December 15, 2007. We included patients in our analysis

Results

During the study period, 100 patients underwent EBUS at our institution; 92 underwent EBUS-FNA. Of these, 56 patients (34 women, 22 men; mean age, 60.4 ± 13.7 years) met our inclusion criteria (Fig 3). The most common indication for EBUS-FNA was assessment of mediastinal lymphadenopathy in the absence of a known malignancy (69.6%). A total of 8 patients completed preoperative chemotherapy; 5 completed preoperative radiation therapy (Table 1). To confirm benign or nondiagnostic EBUS-FNA

Comment

We demonstrated that, after a relatively small number of EBUS-FNA cases (about 10), thoracic surgeons can achieve excellent sensitivity (96.4%) and diagnostic accuracy (97.8%) in the assessment of MLNs. Our EBUS-FNA results were substantiated by confirmatory procedures, such as mediastinoscopy or thoracoscopy. Our findings are in concordance with the findings from other large series of EBUS-FNA cases. Herth and coworkers [31], in a study of 502 patients with mediastinal or hilar

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    Copyright © 2008 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.