Transitioning to Combined EBUS EUS-B FNA for Experienced EBUS Bronchoscopist

• Published in: Diagnostics (Basel) 2021-06, Vol.11 (6), p.1021
• Main Authors: Ng, Jeffrey, Chan, Hiang Ping, Kee, Adrian, Khoo, Kay Leong, See, Kay Choong
• Format: Article
• Language: English
• Subjects: Electronic records; endobronchial ultrasound; endoscopic ultrasound; Endoscopy; Esophagus; Lung cancer; Lymphatic system; mediastinal lymphadenopathy and training endoscopic ultrasound; Patient safety; Supervision; Supervisors; Ultrasonic imaging; Visualization
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics11061021

Endobronchial ultrasound (EBUS) combined with trans-esophageal endoscopic ultrasound bronchoscope guided fine need aspirate (EUS-B FNA) of mediastinal lymph nodes is an established procedure for diagnosis. The main barrier to a combined EBUS EUS-B FNA approach is availability of trained and accredited pulmonologist who can perform procedure safely and confidently. To address this gap, we undertook a training program for experienced EBUS bronchoscopists to train, learn, and incorporate combined EBUS EUS-B FNA into their procedural practice. Thirty-two patients were selected based on CT and or PET findings. Four experienced bronchoscopists participated by reading through learning material, observing 5 cases before performing EUS-B FNA under direct supervision. Forty-one lymph nodes and 6 non-nodal lesions were sampled. EUSAT assessment was performed by supervisor. Learning curves were derived from assessment scores. We observed that learning curve tends to plateau when participant can perform 3 or more consecutive cases with EUSAT score above 50. There were no complications. Our experience suggests that there is relative ease in transition to combined EBUS EUS-B TBNA procedures for mediastinal lymphadenopathy and lung cancer diagnosis and staging for experienced bronchoscopist using a program which incorporates direct supervision, EUSAT assessment, and extension of EUS B FNA training into daily real-world practice.