Diagnostic Performance and Learning Curve of EBUS-Guided TBNA in Western India: A Retrospective Analysis

Jalandra, Ram Niwas; S, Aneesa Shahul; Elhence, Poonam; Dutt, Naveen; Chauhan, Nishant Kumar; Asfahan, Shahir; Deokar, Kunal

Diagnostic Performance and Learning Curve of EBUS-Guided TBNA in Western India: A Retrospective Analysis

Document Type : Original Article

Authors

Ram Niwas Jalandra ¹

Aneesa Shahul S ²

Poonam Elhence ³

Naveen Dutt ⁴

Nishant Kumar Chauhan ⁴

Shahir Asfahan ⁵

Kunal Deokar ⁶

¹ Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India

² Ananthapuri Hospital and Research Institute Thiruvananthapuram, Kerala, India

³ Department of Pathology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India

⁴ Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India

⁵ Department of Pulmonary medicine, All India Institute of Medical Sciences, Jodhpur

⁶ Department of Pulmonary Medicine, All India Institute of Medical Sciences Rajkot, Gujarat, India

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive and highly effective modality for evaluating mediastinal and hilar lymphadenopathy. This study aimed to assess the diagnostic performance and analyze the learning curve of EBUS-guided TBNA during the first two years of its implementation at a tertiary care center in Western India.
Materials and Methods: Retrospective data of EBUS bronchoscopy procedures and their outcomes were collected from the bronchoscopy suite of a tertiary care hospital in Western India. Data were collected using a Google form for the first two years of EBUS operation. The percentage of diagnostic procedures conducted during each quarter was calculated over the two years. The difference in the distribution of determinate to indeterminate procedures between the first and the second year was assessed using the Chi-Square test. Statistical and graphical analyses were performed using Python 3.6.
Results: Based on the cytology reports, out of 144 EBUS procedures conducted, 90 (62.5%) resulted in a diagnosis. Station 7 mediastinal node was the most frequently sampled. Among the determinate procedures, squamous cell carcinoma (31.1%) was the most frequently diagnosed. The average yield for the first four quarters was 57.4%, and for the next four quarters, it was 64.9%. There was a 7.5% increase in yield in the second year of EBUS operation; however, the difference was non-significant (p=0.46).
Conclusion: In the first two years after acquiring EBUS equipment, EBUS-guided TBNA had a diagnostic yield of 62.5% in an academic institute. The diagnostic yield increased during the second year, likely due to a combination of improved operator skills and wise patient selection.

Keywords

Endobronchial ultrasound

Diagnostic yield

Learning curve

Subjects