One Respiratory Physician trained to perform EBUS in a teaching Hospital in the UK and had supervised experience for approximately 50 cases over a period of 1 year.
This learnt skill was taken abroad to another respiratory department with no prior experience in EBUS. One other colleague was nominated to take part and be trained over the introductory period of 9 months.
Typically 2 endoscopy nurses were present, and rotation of staff was controlled to maintain expertise throughout this period. On site Consultant Pathologists and a cytopathology technician were present for each procedure.
Patients underwent standard bronchoscopy then proceeded immediately to EBUS. Moderate conscious sedation was used.
A total of 50 patients went forward for EBUS-TBNA in this period. 25 were female and 25 were men with a mean age of 64.3 and 58 respectively with a range of 20 to 87 years. A total of 56 nodes were performed and the most commonly biopsied nodal stations were 7 (43%) and 4R (42%). Nodal stations biopsied included 2R, 4R, 4L, 7, 10R, and 11R.
The overall accuracy, sensitivity and specificity was 92%, 90% and 100% respectively. The accuracy, sensitivity and specificity for lung cancer diagnosis was 89%, 87% and 100% respectively. The sensitivity and accuracy for sarcoidosis was 100%.
One complication of minor bleeding was noted.
We conclude that a safe and reliable EBUS service can be started in a department where a physician has been involved with 50 cases. We postulate it takes a further 50 cases per consultant to achieve competency and in our department about 9 months at present. We think it is important to control the number of staff performing the procedures initially and this approach is associated with minimal complication and good results for our first cases.
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