Clinical Application Of The Transbronchial Needle Aspiration Biopsy And Its Learning Curve

Background: Bronchoscopic diagnosis was limited initially to cavity diseases.In 1949 Argentina doctor Schieppati invented bronchoscopic needle aspiration biopsy(transbronchial needle aspiration,TBNA).He used a rigid needle through the rigid bronchoscope on the lymph nodes under the needle aspiration biopsy for detecting lung cancer vertical diaphragm transfer case,making the bronchoscope spread from evaluating airway diseases to outside.Then there are European doctors who continued to explore,summed up a lot of experience,but all their work were under rigid bronchoscope.With the wide application of flexible bronchoscope,less and less doctors received rigid bronchoscope training,limiting the promotion of this technology.In 1978,Professor Wang Guoben from Johns Hopkins Hospital also carried out bronchoscope-guided needle aspiration technique,using a rigid bronchoscope to take cytology specimens for tracheal tumor around the right side.Soon he developed a flexible needle,and carried out TBNA in fiberoptic bronchoscopy,expanding the scope of TBNA application.Later he continued improving and positioning the needle puncture method,to create a unique Wang TBNA positioning and a method of operation,so that this method develops into a very useful clinical technology,not only for the diagnosis of mediastinal lesions and lung parenchyma,but also an important method for lung cancer stage diagnosis.Professor Rongfu from Guangdong Province under Professor Wang Guoben,carried out the first clinical application of TBNA and promotion in the China.Transbronchial needle aspiration biopsy,after 30 years of clinical application,significantly improves the diagnostic rate with bronchoscopy.Without TBNA technology,18%to 38% of patients would have missed confirmed diagnosis.After years of clinical application,TBNA has become a practical,highly safe clinical technique,which greatly complements the diagnosis of bronchial mediastinal and hilar parts illness,but has not yet reached widespread clinical application.the reason for it is operatively associated with the presence of a certain degree of difficulty,the unskilled operator with the mediastinal anatomy,and also fear of damage to vital organs and blood vessels and hence leading to major complications.So many experienced respiratory physicians retreat halfway,giving up the application of this technology.With the clinical application of EBUS-TBNA,the doctors have a better understanding of the diagnosis of mediastinal disease,but expensive prices prevent it from full operations in the short term.In recent years,a number of comparative studies show that when doctors with good TBNA technical proficiency implement mediastinal lymph node biopsy,the positive rate of conventional TBNA and EBUS-TBNA has no significant difference,which makes those Doctors who have abandoned conventional TBNA or have little interest in conventional TBNA start to focus on the operation of the application of conventional TBNA.To improves clinicians conventional TBNA application,the first thing is to erase doctors' worry about unclear mediastinal vessels and damage problems.Wang TBNA location method provides a good theoretical basis and practical guidance for technology.Meanwhile TBNA as a minimally invasive technique,has good tolerability,very few complications,and no serious bleeding,which is a safe diagnostic technique.But for TBNA learning curve,as to how many cases are needed minimally to master this invasive technique,reports in this regard are currently small.Objective: To evaluate transbronchial needle aspiration biopsy puncture results,investigate the clinical value of TBNA and to explore the learning curve of transbronchial needle aspiration biopsy for respiratory physicians who have mastered the skills of bronchoscopy.Methods: select the clinical data of first 60 patients of TBNA check in Second People's Hospital of Wuhu from May 2014 to August 2015.by the order of TBNA operation,the patients are divided into four groups(A,B,C,D),15 patients in each group set as a learning phase,each fed with TBNA examination.Compare the average time of each stage of puncture,puncture complications and positive biopsy rate among groups.Result: Each group of patients showed no significant difference in gender,age,etc.(all P> 0.05).Puncture time of group A(11.6 ± 1.6)min was significantly longer than group C(6.1 ± 1.0)min or group D(5.6 ± 1.3)min(P <0.05),group B puncture time(11.5 ± 2.2)min also significantly longer in group C or group D(P <0.05),and the difference between groups C and D being not statistically significant(P =0.211);for the positive rate after the puncture,group A(4/15)was significantly lower than group C(11/15)or group D(12/15)(P <0.05),group B(5/15)also significantly lowered than group C or group D(P <0.05);group C and D bear no statistical difference between the them in significance(P =0.065).Complications in each group like intravascular puncture,after-puncture bleeding,pneumothorax,mediastinal hematoma,mediastinal bleeding and mediastinal infection were not significantly different.Conclusion: Transbronchial needle aspiration biopsy has high clinical value and safety,and its learning curve is about 30 cases.