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.

Holty JE, Kuschner WG, Gould MK: Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax 2005;60:949–955.
Hermens FH, Van Engelenburg TC, Visser FJ, Thunnissen FB, Termeer R, Janssen JP: Diagnostic yield of transbronchial histology needle aspiration in patients with mediastinal lymph node enlargement. Respiration 2003;70:631–635.
Fernández-Villar A, Leiro V, Blanco M, Represas C, Botana M, González A, Piñeiro L: Efficacy and safety of the eXcelon transbronchial aspiration needle in mediastinal lymph node enlargement: a case-control study. Respiration 2007;74:208–213.
Diacon AH, Schuurmans MM, Theron J, Louw M, Wright CA, Brundyn K, Bolliger CT: Utility of rapid on-site evaluation of transbronchial needle aspirates. Respiration 2005;72:182–188.
Herth FJ, Lunn W, Eberhardt R, Becker HD, Ernst A: Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes. Am J Respir Crit Care Med 2005;171:1164–1167.
Becker HD: EBUS: a new dimension in bronchoscopy. Of sounds and images – a paradigm of innovation. Respiration 2006;73:583–586.
Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A: Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax 2006;61:795–798.
Khoo KL, Chua GS, Mukhopadhyay A, Lim TK: Transbronchial needle aspiration: initial experience in routine diagnostic bronchoscopy. Respir Med 2003;97:1200–1204.
Sharafkhaneh A, Baaklini W, Gorin AB, Green L: Yield of transbronchial needle aspiration in diagnosis of mediastinal lesions. Chest 2003;124:2131–2135.
Wang KP: Transbronchial needle aspiration; how I do it. J Bronchol 1994;1:63–68.
Mountain CF, Dressler CM: Regional lymph node classification for lung cancer staging. Chest 1997;111:1718–1723.
Wang KP, Terry PB: Transbronchial needle aspiration in the diagnosis and staging of bronchogenic carcinoma. Am Rev Respir Dis 1983;127:344–347.
Haponik EF, Shure DS: Underutilization of transbronchial needle aspiration: experiences of current pulmonary fellows. Chest 1997;112:251–253.
Herth F, Becker HD, Ernst A: Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. Chest 2004;125:322–325.
Bernasconi M, Chhajed PN, Gambazzi F, Bubendorf L, Rasch H, Kneifel S, Tamm M: Combined transbronchial needle aspiration and positron emission tomography for mediastinal staging of NSCLC. Eur Respir J 2006;27:889–894.
Rodríguez de Castro F, Díaz López F, Serdà GJ, López AR, Gilart JF, Cabrera Navarro P: Relevance of training in transbronchial fine-needle aspiration technique. Chest 1997;111:103–105.
Haponik EF, Cappellari JO, Chin R, Adair NE, Lykens M, Alford PT, Bowton DL: Education and experience improve transbronchial needle aspiration performance. Am J Respir Crit Care Med 1995;151:1998–2002.
Hsu LH, Liu CC, Ko JS: Education and experience improve the performance of transbronchial needle aspiration. Chest 2004;125:532–540.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.