RESUMO
Conventional transbronchial needle aspiration [C-TBNA] is a minimally invasive, safe, and cost-effective technique in evaluating mediastinal lymphadenopathy. Previously we reported that the skills for C-TBNA can be acquired from the books. We studied the learning curve for C-TBNA for a single bronchoscopist at a tertiary-care center where ultrasound technology remains difficult to acquire. We prospectively collected results of the first 99 consecutively performed C-TBNA between December 2009 and 2013. Patients were divided into 3 groups: [I]: First 33, [II]: Next 33 and [III]: Last 33. Results were categorized as malignant, non-malignant or non-diagnostic. Diagnostic yield [DY], sensitivity [SEN], specificity [SPE], positive and negative predictive values [PPV, NPV], and accuracy [ACC] were calculated to learn the learning curve for C-TBNA. Total 99 patients [M:F = 62:37], mean age 58.2 +/- 11.5 years, mean LN diameter 26.9 +/- 9.8 mm underwent C-TBNA. Sixty-nine patients had lymph nodes [LNs] >20 mm in diameter. Final diagnoses were established by C-TBNA in 44 [yield 44.4%], mediastinoscopy 47, transthoracic needle aspiration 5, endobronchial biopsy 2 and peripheral LN biopsy 1. C-TBNA was exclusively diagnostic in 35.4%. Group I: DY: 42.4%, 64.7% in malignancies, 19% in benign conditions [P = 0.008]. SEN, SPE, PPV, NPV, ACC = 70%, 100%, 100%, 66.6%, 78.7%, respectively. Group II: DY: 54.5% [36.4% exclusive], 88.2% in malignancies and 19% benign conditions [P = 0.000]. SEN, SPE, PPV, NPV, ACC=72%, 100%, 100%, 53.3%, 78.7%, respectively. Group III: DY: 36.3% [27% exclusive], 100% in malignancies and 16% in benign conditions. SEN, SPE, PPV, NPV, ACC = 92.3%, 100%, 100%, 95.2%, 97%, respectively. No difference was found in relation to LN size or location and TBNA yield. C-TBNA can be easily learned and the proficiency can be attained with <66 procedures. In selected patients, its exclusivity could exceed 35%