[398] Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS): The Impact on the Cytology Laboratory

Sharmeen Mansoor, Lynn M O'Donnell, Jeffery C West, Mary S Chacho. Danbury Hospital, Danbury, CT

Background: Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS) plays an important role in the staging of lung carcinoma and allows sampling of intrathoracic lymph nodes. EBUS has great impact on any Cytology laboratory. All slides, including cell block slides, are reviewed in the laboratory, each requiring approximately 5 minutes for review. This overall process consumes hours of cytotechnologist time. Time spent away from the laboratory to assist in such procedures limits the time left in the day for cytotechnologists to screen slides. Also, strict federal and state laws limit the number of slides that a cytotechnologist may see in any 24 hour period to 100, a number that is prorated for an 8 hour work day. In such circumstances, the laboratory risks exhausting the legal capacity of the cytotechnologists' screening time. Although time consuming to the laboratory, EBUS offers advantages to patients when compared to mediastinoscopy. Our objective is to retrospectively study all the slides made at each procedure and identify any trends in sampling that may lead to more efficiency in the performance of this procedure.
Design: 203 cases from 92 patients who had EBUS lymph node sampling, collected from March 2009 through August 2011 in Danbury Hospital, were retrospectively reviewed in their entirety. Cases include direct smears, ThinPrep slides and cell block slides.
Results: Of all the cases, 2238 total slides were made with an average of 11 slides per case (range 3-39).

 No. Of cases (sites)Total no. Of slidesAverage no. Of slides per site (range)Cytotech time screening per site (minutes)
Diagnostic cases4953611 (3-25)55
Non-diagnostic cases153170211.12 (3-39)55.6
* One case of Hodgkin lymphoma is excluded

At least two different lymph node sites were sampled per patient. The average total time consumed by cytotechnologists, including their time spent in the endoscopy suite (75 min per cytotech) per patient is approximately, on average 260 minutes (4.3 hours).
Conclusions: EBUS offers advantages to patients, however, the impact on the Cytology lab is significant, particularly in view of the strict federal laws limiting the workload of cytotechnologists. The value of this time-consuming and labor-intensive technique is not reflected in measures of the laboratory's productivity or RVUs (relative value units). Review of all slides revealed that the ThinPrep and cell block in the vast majority of cases contained diagnostic cells, suggesting that there may not be a need to prepare as many smears as is currently done.
Category: Cytopathology

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 74, Wednesday Afternoon

 

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