{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T16:48:40Z","timestamp":1758127720943},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:p>Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) has become a widely available tool that allows sampling of mediastinal and hilar lymph nodes with comparable accuracy as compared with the gold standard procedure, mediastinoscopy. The goal of this study was to evaluate the competence accuracy of this technique in academic medical center in patients with and without malignant disease. This was a retrospective chart review of the first 150 patients who underwent EBUS-TBNA at our institution with an operator not previously trained or supervised while performing the procedure. All nondiagnostic results were confirmed with mediastinoscopy. The cumulative sum analysis is a method used to continuously monitor performance against an established standard to attain competence in the procedure performed. Learning curve was assessed using cumulative sum method. Procedures were divided into sextiles (1\u201325, 26\u201350, 51\u201375, 76\u2013100, 101\u2013125, and 126\u2013150). The technique's diagnostic accuracy was calculated for each of the 6 categories and trend toward improved accuracy was assessed using Cochran\u2013Armitage trend test. Operator competency was achieved between 55th and 60th procedures. The diagnostic accuracy increased from 72% to 88% (from the first to third sextile) but remained stable afterwards at 88% (C-A trend test <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.091). The overall diagnostic accuracy was 84%. Trainees' learning rate varies while acquiring adequate knowledge. We suggest that a learning curve for each operator be used to assess competence in EBUS-TBNA procedure before physicians perform it without supervision.<\/jats:p>","DOI":"10.1097\/mjt.0000000000000050","type":"journal-article","created":{"date-parts":[[2014,3,11]],"date-time":"2014-03-11T14:34:40Z","timestamp":1394548480000},"page":"e1016-e1019","source":"Crossref","is-referenced-by-count":5,"title":["Endobronchial Ultrasound\u2013Transbronchial Needle Aspiration of Mediastinal and Hilar Lymphadenopathy Learning Curve"],"prefix":"10.1097","volume":"23","author":[{"given":"Fayez","family":"Kheir","sequence":"first","affiliation":[{"name":"Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Alokla","sequence":"additional","affiliation":[{"name":"Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leann","family":"Myers","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime","family":"Palomino","sequence":"additional","affiliation":[{"name":"Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA; and"},{"name":"Section of Pulmonary Diseases, Southeast Louisiana Veterans Healthcare System, New Orleans, LA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20230917","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.jtcvs.2011.08.037","article-title":"A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer","volume":"142","author":"Yasufuku","year":"2011","journal-title":"J Thorac Cardiovasc Surg."},{"key":"R2-20230917","first-page":"356","article-title":"ERS\/ATS statement on interventional pulmonology. European Respiratory Society\/American Thoracic Society","volume":"19","author":"Bolliger","year":"2002","journal-title":"Eur Respir J."},{"key":"R3-20230917","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1378\/chest.123.5.1693","article-title":"Interventional pulmonary procedures: guidelines from the American College of Chest Physicians","volume":"123","author":"Ernst","year":"2003","journal-title":"Chest"},{"key":"R4-20230917","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1378\/chest.12-2462","article-title":"Point: are >50 supervised procedures required to develop competency in performing endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging? 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No","volume":"143","author":"Kinsey","year":"2013","journal-title":"Chest"},{"key":"R6-20230917","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/intqhc\/12.5.433","article-title":"The use of the cusum technique in the assessment of trainee competence in new procedures","volume":"12","author":"Bolsin","year":"2000","journal-title":"Int J Qual Health Care."},{"key":"R7-20230917","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1136\/bmj.304.6838.1359","article-title":"Quality control: an application of the cusum","volume":"304","author":"Williams","year":"1992","journal-title":"BMJ"},{"key":"R8-20230917","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1093\/bja\/75.6.805","article-title":"A statistical approach to measuring the competence of anaesthetic trainees at practical procedures","volume":"75","author":"Kestin","year":"1995","journal-title":"Br J Anaesth."},{"key":"R9-20230917","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1136\/thx.2009.127274","article-title":"Learning curves for endobronchial ultrasound using cusum analysis","volume":"65","author":"Kemp","year":"2010","journal-title":"Thorax"},{"key":"R10-20230917","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1164\/rccm.201111-1968OC","article-title":"Endobronchial ultrasound skills and tasks assessment tool: assessing the validity evidence for a test of endobronchial ultrasound-guided transbronchial needle aspiration operator skill","volume":"186","author":"Davoudi","year":"2012","journal-title":"Am J Respir Crit Care Med."},{"key":"R11-20230917","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1378\/chest.11-1986","article-title":"The endobronchial ultrasound-guided transbronchial needle biopsy learning curve for mediastinal and hilar lymph node diagnosis","volume":"141","author":"Fern\u00e1ndez-Villar","year":"2012","journal-title":"Chest"},{"key":"R12-20230917","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1378\/chest.12-0317","article-title":"Learning curve for endobronchial ultrasound-guided transbronchial needle aspiration","volume":"141","author":"Medford","year":"2012","journal-title":"Chest"},{"key":"R13-20230917","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/j.ejca.2008.11.043","article-title":"Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis","volume":"45","author":"Gu","year":"2009","journal-title":"Eur J Cancer."},{"key":"R14-20230917","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1183\/09031936.00097908","article-title":"Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review","volume":"33","author":"Varela-Lema","year":"2009","journal-title":"Eur Respir J."},{"key":"R15-20230917","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1378\/chest.10-2914","article-title":"Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry","volume":"140","author":"Ost","year":"2011","journal-title":"Chest"}],"container-title":["American Journal of Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00045391-201607000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T04:01:57Z","timestamp":1694923317000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00045391-201607000-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.1097\/mjt.0000000000000050","relation":{},"ISSN":["1075-2765"],"issn-type":[{"value":"1075-2765","type":"print"}],"subject":[],"published":{"date-parts":[[2016,7]]}}}