Abstract Rationale Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays an integral role in the evaluation and diagnosis of benign or malignant lung disease. Appropriate training in technique and anatomy is imperative to its optimal utilization. Yield varies depending on technique, experience/case volume, patient factors/complications, number of passes, pathology support, and rapid on-site evaluation (ROSE). This quality improvement (QI) initiative aims to evaluate EBUS procedures performed at Norwalk and Danbury Hospitals (Nuvance East), two community-based academic medical centers without subspecialty interventional pulmonologists. Systematic review of EBUS for quality metrics has been difficult with limitations in IT systems creating the need for manual data pull. We aim to identify areas for improvement, and to implement institutional level changes for the improvement in quality of care. Methods This retrospective study analyzed EBUS-TBNA procedures performed in Nuvance East between January 1, 2024, and December 31, 2024. Data was collected from electronic medical records including patient demographics, procedural details, pathologic diagnosis (including malignant or nonmalignant), staging, and complications (defined as unexpected hospital admission post-procedure, significant hemoptysis, respiratory failure, aspiration, death, or other). We also examined whether clinical diagnosis matched the final pathologic diagnosis, and if sampling was adequate. Results A total of 59 procedures were reviewed with only 1 terminated for inability to get adequate tissue. There were no recorded complications in any of the patients. Of the 59 patients, 36 (61%) had a malignant diagnosis. Of those, 22 (61%) were adenocarcinoma, 5 (14%) squamous cell lung, 3 (8%) carcinoid, 2 (5.5%) lymphoma, and 1 each (2.8%) of mesothelioma, melanoma, and a preliminary NSCLC still awaiting differentiation. Of the remaining 23 patients, 5 (22%) had no definitive diagnosis, 2 (9%) were granulomatous, 2 had “other” benign etiologies, and there was 1 case each of chronic aspiration, ILD, and organizing pneumonia. ROSE was used in 42% of cases. Sampling was adequate in 85% with pathology matching clinical diagnosis in 64% of cases. However, 11 patients (19%) required a subsequent procedure for definitive diagnosis. When ROSE was used, clinical and pathological diagnoses matched in 76% vs 56% when ROSE was not used. Conclusion This ongoing EBUS-TBNA QI project aims to assess the current performance of EBUS-TBNA procedures within Nuvance East. By identifying procedural and logistic pitfalls and variability in current practices, we intend to use ongoing prospective data to guide institutional changes to improve diagnostic accuracy, procedural safety, and overall patient care. This abstract is funded by: None
Jain et al. (Fri,) studied this question.