Training in EUS-Guided Fine Needle Aspiration: Safety and Diagnostic Yield of Attending Supervised, Trainee-Directed FNA from the Onset of Training. (24th November 2011)

• Record Type: Journal Article
• Authors: Coté, Gregory A.; Hovis, Christine E.; Kohlmeier, Cara; Ammar, Tarek; Al-Lehibi, Abed; Azar, Riad R.; Edmundowicz, Steven A.; Mullady, Daniel K.; Krigman, Hannah; Ylagan, Lourdes; Hull, Michael; Early, Dayna S.
• Other Names: Tham Tony C. K. Academic Editor.
• Is Part Of: Diagnostic and therapeutic endoscopy. Volume 2011(2011)
• Publication Date: 2011-11-24
• Subjects: Endoscopy -- Periodicals; Endoscopie; Endoscopy; Endoscopy -- Periodicals; Electronic journals; Periodicals; 616.07545
• DOI: 10.1155/2011/378540
• Languages: English
• ISSNs: 1070-3608

Abstract

Abstract : Background . The optimal time to initiate hands-on training in endoscopic ultrasound fine needle aspiration (EUS-FNA) is unclear. We studied the feasibility of initiating EUS-FNA training concurrent with EUS training. Methods . Three supervised trainees were instructed on EUS-FNA technique and allowed hands-on exposure from the onset of training. The trainee and attending each performed passes in no particular order. During trainee FNA, the attending provided verbal instruction as needed but no hands-on assistance. A blinded cytopathologist assessed the adequacy (cellularity) and diagnostic yield of individual passes. Primary outcomes compared cellularity and diagnostic yield of attending versus fellow FNA passes. Results . We analyzed 305 FNA sites, including pancreas (51.2%), mediastinal/upper abdominal lymph node (LN) (28.5%) and others (20.3%). The average proportion of fellow passes with AC was similar to attending FNA—pancreas: 70.3 versus 68.8%; LN: 79.0 versus 81.7%; others 65.5 versus 68.7%; P > 0.05); these did not change significantly during the training period. Among cases with confirmed malignancy ( n = 179), the sensitivity of EUS-FNA was 78.8% (68.4% fellow-only versus 69.6% attending only). There were no EUS-FNA complications. Conclusions . When initiated at the onset of EUS training, attending-supervised, trainee-directed FNA is safe and has comparable performance characteristics to attending FNA.