UNDERUTILIZATION OF TRANSBRONCHIAL NEEDLE ASPIRATION - EXPERIENCES OFCURRENT PULMONARY FELLOWS

Transbronchial needle aspiration (TBNA) is a valuable, minimally invas ive procedure for diagnosing and staging lung cancer in patients, but it is underutilized by practicing pulmonologists, To assess the approa ch to TBNA of current pulmonary Fellows, we recorded their computerize d interactive responses during the 1995 American College of Chest Phys icians Fellows' Conference. Among 109 Fellows attending, only 10% repo rted that they routinely (greater than or equal to 85% of cases) perfo rmed TBNA to diagnose or stage malignant disease, and 40% noted that t hey rarely (less than or equal to 5% of cases) pet-formed it. They est imated their diagnostic TBNA yields in patients with mediastinal cance r as follows: greater than or equal to 80% by 2% of Fellows; between 2 5% and 80% by 54% of Fellows; and <25% by 45% of Fellows. They noted t hat the main limitations of TBNA at their institutions were suboptimal bronchoscopy technique (30%), technician support (1%), cytopathology support (14%), all of these factors (25%), or the belief that TBNA is not useful (30%), TBNA is currently underutilized and/or underemphasiz ed at bronchoscopy training programs. Major modifications of Fellow ex periences are necessary if TBNA is to impact optimally on patient mana gement.