Self-learning experience in transbronchial needle aspiration in diagnosis of intrathoracic lymphadenopathy

Abstract

Background: Lack of a training program and experience result in underutilized transbronchial needle aspiration (TBNA). Pulmonologists who are not graduated from Europe or the United States might have little chance to learn and gain experience in this procedure. Objective: To determine the authors' diagnostic yield from self-learning TBNA in diagnosis of intrathoracic lymphadenopathy. Material and Method: After reviewing a videotape recorded TBNA procedure repetitively and receiving training in tracheobronchial lung model, the authors performed TBNA according to standard techniques using 21-guage cytology needles connected to a flexible bronchoscope in diagnosis of intrathoracic lymphadenopathy and performed data collection on all TBNA procedures at Ramathibodi Hospital, a tertiary university hospital in Bangkok, Thailand between January 1, 2006 and December 31, 2007. Results: Thirty-eight consecutive patients were examined. Twenty-seven nodes (71.1%) were malignancies and 11 nodes (28.9%) were benign diseases. During the first 6-month, the authors' diagnostic yield and frequency of adequate specimens were low. With some modification of the TBNA technique and learning experience, the frequency of inadequate specimens significant decreased from 36.4% to 0% (p = 0.03). Although the diagnostic yield increased from 45.5% to 84.6%, it did not reach statistical significance (p = 0.09). No complication, in either the patients or the bronchoscopes, was found. Conclusion: TBNA is a safe procedure that can be self-mastered by pulmonologists with interest, intent, and who exert themselves. TBNA performance will be improved over time with practice.