Education and Experience Improve the Performance of Transbronchial Needle Aspiration

Hsu, Li‐Han; Liu, Chia‐Chuan; Ko, Jen‐Sheng

doi:10.1378/chest.125.2.532

Cited by 92 publications

(66 citation statements)

References 24 publications

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“…The 84% on-site yield with P-ROSE was consistent with a previous study from our group, where P-ROSE recognised 85% of positive TBNA [8]. Other studies have associated ROSE with a higher yield of TBNA [6,7], better aspirate quality [6,12], educational value [12], improved quality of service [7,8,10] and cost-effectiveness, Data are presented as n (%). G-ROSE: Wright-Giemsa-based rapid on-site evaluation; P-ROSE: Papanicolaou-based rapid on-site evaluation.…”

Section: Discussionsupporting

confidence: 87%

Rapid on-site evaluation of transbronchial aspirates: randomised comparison of two methods

Diacon¹,

Koegelenberg²,

Schubert³

et al. 2009

European Respiratory Journal

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The value of different staining methods for rapid analysis of transbronchial needle aspirates during bronchoscopy has not been explored.In the present study, we compared a Papanicolaou-based rapid stain, prepared by a technologist and read by a cytopathologist, and a Wright-Giemsa-based rapid stain, prepared and read by a cytopathologist alone. Gold standard was the final laboratory report issued on each aspirate.We harvested 827 aspirates from 218 target sites in 126 consecutive patients. At least one positive aspirate was found in 99 (79%) patients. In those 99 patients, 288 of 574 (50%) aspirates were positive for neoplastic (83%) or non-neoplastic (17%) disease. False-negative aspirates and target sites were more frequent with the rapid Wright-Giemsa than with the rapid Papanicolaou stain (14.2 versus 7.3%, p50.008, and 13.7 versus 3.6%, p50.021, respectively). The sensitivity of the Wright-Giemsa-based and Papanicolaou-based rapid stains for detecting diagnostic material was 93 and 100% in patients, 83.1 and 95.5% in target sites, and 72.8 and 84.9% in aspirates, respectively. Specificity was 100% for both methods in patients and target sites, and 90.4 and 95% in aspirates.We concluded that a Papanicolaou-based stain has superior yield and accuracy to a WrightGiemsa-based stain for rapid on-site evaluation of transbronchial needle aspirates.KEYWORDS: Biopsy, bronchoscopy, cytodiagnosis, fine-needle, lung neoplasms T ransbronchial needle aspiration (TBNA) via flexible bronchoscopy (FB) is a wellestablished sampling method for a variety of neoplastic and non-neoplastic lung lesions [1]. Its ability to establish a diagnosis and to permit staging in a single intervention has made TBNA the key technique for the evaluation of patients with suspected lung cancer [2][3][4]. Endobronchial ultrasound and rapid on-site evaluation (ROSE) have been shown to improve TBNA yield [5][6][7][8][9]. ROSE-TBNA provides the bronchoscopist with real-time guidance and allows for termination of sampling when the diagnostic objective has been met. This increases patient comfort and reduces cost [8,10]. A formal off-site review involving routine and ancillary staining methods, e.g. for microorganisms and immunocytochemistry is obligatory to confirm provisional ROSE results.Experienced bronchoscopists harvest TBNA samples in quick succession by repetitively aspirating multiple target sites to minimise false-negative results. To fulfil its purpose, a ROSE procedure must keep up with the pace of sampling. Onsite staining methods must therefore find a compromise between speed, ease of preparation and staining quality. Commonly used fast stains are modified versions of standard laboratorybased staining methods. Wright-Giemsa-based rapid stains are water-based and provide mainly cytoplasmic definition on air-dried slides. Such procedures are not labour-intensive and allow staining and evaluation by a single person. Alcohol-based modified Papanicolaou stains on alcohol-fixed slides are more time consuming but provide superior demo...

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Section: Discussionsupporting

confidence: 87%

Rapid on-site evaluation of transbronchial aspirates: randomised comparison of two methods

Diacon¹,

Koegelenberg²,

Schubert³

et al. 2009

European Respiratory Journal

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“…2). This effect is expected and has been described previously [17,18], although a recent study reported high initial diagnostic yield by a team of experienced bronchoscopists [19]. TBNA requires no capital investment, was first described via FB more than 25 yrs ago, is cost-effective and very safe [5,20].…”

Section: Thoracic Oncology Mg Slade Et Alsupporting

confidence: 55%

Improving standards in flexible bronchoscopy for lung cancer

Slade¹,

Rahman²,

Stanton³

et al. 2010

Eur Respir J

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Can the detection rate of flexible bronchoscopy for lung cancer be increased by a series of simple quality improvement measures?Bronchoscopy . Prior computed tomography availability was associated with a higher diagnostic yield that did not reach statistical significance. Logistic regression analysis identified tumour visibility, year of study, use of transbronchial needle aspiration and pathologist identity as independent predictors of a positive diagnosis.A significant increase in bronchoscopic detection rate for malignancy occurred in association with a number of simple improvement measures.

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“…In addition, the results of this study were related to lymph node size. The study by Hsu et al [18] has the same limitations.…”

Section: Discussionmentioning

confidence: 98%

Learning Curve of Conventional Transbronchial Needle Aspiration in Pulmonologists Experienced in Bronchoscopy

Hermens

Limonard²,

Termeer³

et al. 2007

Respiration

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Background: Despite its proven efficacy, transbronchial needle aspiration (TBNA) remains an underutilized technique for sampling enlarged mediastinal lymph nodes in the staging of lung cancer. Previous investigators have reported on TBNA experience, but without mentioning individual learning curves related to lymph node size in pulmonologists experienced in bronchoscopy. Objectives: The aim of this study was to evaluate the TBNA learning curve in a group of pulmonologists already experienced in bronchoscopy, and to relate their yields to lymph node size and location. Methods: Data on TBNA yield and related lymph node size were collected retrospectively for five individual pulmonologists. Results: The diagnostic yield of five pulmonologists who started to perform TBNA was evaluated over the first 32 months. TBNA was performed on 138 lymph nodes in 119 patients. The overall diagnostic yield was 77% (range 67–91%). The average diagnostic yield increased from 77% at the start of the learning curve to 82% after 32 months of experience. It was related to lymph node size, but not to lymph node location. The average lymph node size was 22 mm. Conclusions: Satisfactory results were obtained immediately after introduction of TBNA in the bronchoscopy workup. There is no significant TBNA learning curve. The diagnostic yield was related to lymph node size but not to lymph node location.

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Education and Experience Improve the Performance of Transbronchial Needle Aspiration

Cited by 92 publications

References 24 publications

Rapid on-site evaluation of transbronchial aspirates: randomised comparison of two methods

Rapid on-site evaluation of transbronchial aspirates: randomised comparison of two methods

Improving standards in flexible bronchoscopy for lung cancer

Learning Curve of Conventional Transbronchial Needle Aspiration in Pulmonologists Experienced in Bronchoscopy

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