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The learning curve for EBUS-TBNA
  1. Neal Navani1,
  2. Matthew Nankivell2,
  3. Parthiban Nadarajan1,
  4. Stephen P Pereira3,
  5. Gabrijela Kocjan4,
  6. Sam M Janes1
  1. 1Centre for Respiratory Research, University College London, London, UK
  2. 2MRC Clinical Trials Unit, London, UK
  3. 3Department of Gastroenterology, University College London Hospital, London, UK
  4. 4Department of Cytology, University College Hospital, London, UK
  1. Correspondence to Dr Sam Janes, Centre for Respiratory Research, University College London, 5 University Street, London WC1E 6JF, UK; s.janes{at}

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We read with interest the paper by Kemp and colleagues1 which utilises cumulative sum (CUSUM) to analyse the learning curves associated with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The retrospective study from five centres demonstrated that variable learning periods are required to attain proficiency in the procedure, and a pooled sensitivity of 67.4% was observed.

The authors are to be commended on using CUSUM to calculate the learning curves for EBUS-TBNA; however, several points deserve comment. First the study only includes patients undergoing EBUS-TBNA for the diagnosis or staging of lung cancer. In clinical practice, the procedure is also commonly employed for the diagnosis of isolated mediastinal lymphadenopathy, and these procedures should be incorporated in the learning process. Secondly, the …

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  • Funding NN is Medical Research Council Research Training Fellow; PN is funded by a ERS Long Term Research Fellowship; SMJ is Welcome Trust Senior Research Fellow.

  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.