Performing EBUS-TBNA (Endobronchial Ultrasound Transbronchial Needle
Aspiration) to Diagnose NSCLC (Non-small Cell Lung Cancer)
Background
Lung cancer currently leads cancer-related mortalities in the US, responsible for more deaths than colon,
breast, and prostate cancers combined. The most common lung cancer is non-small cell lung cancer
(NSCLC), which accounts for approximately 85% of all lung cancers. Stage at diagnosis is the most
important indicator of survival; high rates of death for lung cancer are, in part, due to that more than 75% of
lung cancers are diagnosed at advanced stages. The five-year survival rates for all stages of NSCLC are
around 15%. The evolution in scientific understanding of targeted therapy and personalized care has
generated a need for emphasis on diagnosis of NSCLC and the assessment of individualized, molecular
markers.
In order to appropriately assess for molecular markers, it is imperative that adequate tissue samples be
obtained and provided to the pathologist. The ACCP Quality Improvement Registry, Evaluation, and
Education (AQuIRE) currently includes two relevant resources: (1) the Interventional Bronchoscopy
Registry; and (2) the Diagnostic Bronchoscopy Registry. The main goal of these registries is to collect
standardized data on practice patterns of various disciplines from multiple centers. This standardized data
facilitates measurement of diagnostic yield, complication rates, adverse events, and efficacy of
interventions. It also includes the necessary co-variants to allow for risk-adjusted measures.
This performance improvement module (PIM) is designed to improve clinicians’ skills in collecting adequate
tissue samples for diagnosis and management. It will provide education as well as process improvements
for enhancing clinical performance and overcoming barriers.
Project Goals
1. Increase the diagnostic yield per patient of physicians performing EBUS-TBNA to 70% within one year
(or by completion of the activity).
2. Reduce or maintain EBUS-TBNA-related complications within one year (or by completion of the activity)
to 4%.
3. Address barriers associate with obtaining adequate tissue samples to support the diagnosis and
eventual management of NSCLC.
Target Audience
This activity is designed for clinicians that perform EBUS-TBNA.
Measures
The following clinical measures have been selected for this activity:
1. Risk stratified (by lymph node size) per patient yield of EBUS TBNA of lymph nodes for a specific
diagnosis made.
Type:
Outcome
Source:
Diagnosis and Management of Lung Cancer: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines (2nd Edition)
This measure is used to assess the percent of patients who had EBUS TBNA performed targeting a
mediastinal or hilar lymph node and had a specific diagnosis made.
2. Risk stratified (by lymph node size) per lymph node yield of EBUS TBNA for either a specific diagnosis
made or adequate lymphocytes.
Type:
Outcome
Source:
Diagnosis and Management of Lung Cancer: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines (2nd Edition)
This measure is used to assess the percent of specific diagnoses made or adequate lympocytes
obtained when performing an EBUS TBNA.
3. Per patient complication rate as a result of EBUS-TBNA.
Type:
Outcome
Source:
Complications Related to Endobronchial Ultrasound Guided Transbronchial Needle
Aspiration by ACCP Quality Improvement Registry Education and Evaluation (AQuIRE)
Participants
This measure is used to assess the percent of patients who had EBUS TBNA that resulted in a
complication.
Performance EBUS-TBNA to Diagnose NSCLC PIM Process
In order to complete this on-line activity, you will progress through three stages sequentially:
Stage A: Self Assessment and Practice Assessment
 Complete a web-based Knowledge Assessment.
 Complete web-based Self and Practice Assessment.
 Collect data for 25 patients by one of the following options:
-If you participate in the AQuIRE Diagnostic Bronchoscopy Registry your patient data will be
entered directly from the Registry.
-If you do not use AQuIRE, you will be asked to use a web-based tool to collect patient data.
In order for the patient to valid to be entered into the PIM, the patients:
 Must have undergone EBUS-TBNA at one or more lymph nodes.
 The procedure must have been indicated for the following:
o Mediastinal lymph node
o Hilar lymph node
 Review performance data with the care team.
 Evaluate the activity at the end of Stage A.
Stage B: Interventions for Improvement—To start within 30 days following chart review
 Complete the required web-based educational activities:
o 3-D Bronchoscopy Anatomy Application
o Bronchoscopy Function Specification modules



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o Virtual Bronchoscopy Simulator
Review performance improvement resources.
Use the web-based Action Plan template to develop a strategy for performance improvement.
Implement systems-based tools over a 30-day period.
Evaluate the activity at the end of Stage B.
Stage C: Reassess (repeat Stage A)—To start after 30-day intervention implementation period
 Complete web-based Self and Practice Assessment.
 Collect data for 25 patients by one of the following options:
-If you participate in the AQuIRE Diagnostic Bronchoscopy Registry your patient data will be
entered directly from the Registry.
-If you do not use AQuIRE, you will be asked to use a web-based tool to collect patient data.
In order for the patient to valid to be entered into the PIM, the patients:
 Must have undergone EBUS-TBNA at one or more lymph nodes.
 The procedure must have been indicated for the following:
o Mediastinal lymph node
o Hilar lymph node
 Compare your Stage A data to Stage C data.
 Analyze individual performance.
 Benchmark against other participants. As in Stage A, you will see a report that shows anonymous peer
comparisons of all participants.
 Team Analysis/Reflection—teams should review changes in practice and refine improvements based
on new data.
 Evaluate the activity at the end of Stage C.
Collecting Your Credit
20 AMA PRA Category 1 credits™ (CME)
Upon completion of the Stage C Evaluation, you will receive 20 AMA PRA Category 1 credits™. Those credits
can be found under the Transcript Tab in the “Performing EBUS-TBNA to Diagnose NSCLC PIM” web portal.
10 ABIM MOC Part II Points
Upon completion of the Knowledge Assessment at the beginning of Stage A, if you have entered your
American Board of Internal Medicine (ABIM) diplomat number, 10 ABIM MOC Part II points will be
automatically transmitted to the ABIM and the ABIM will grant the points upon receipt of verification of
participation.
20 ABIM MOC Part IV Points
Upon completion of the Stage C Evaluation, you can attest to participation and receive 20 ABIM MOC Part IV
points by submitting a report to ABIM through the Physician Homepage on www.abim.org. Participants can
login using their ABIM ID and password and click “Submit AQI Project Report” listed under “My Maintenance of
Certification Program.” ABIM will grant MOC points after the ACCP verifies participation in the activity.
Credit Statements
ACCME Accreditation:
The ACCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians.
AMA Credit Designation:
The ACCP designates this performance improvement (PI) CME activity for a maximum of 20.0 AMA PRA
Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their
participation in the activity.
Physicians who complete only one or two stages will be awarded 5 AMA PRA Category 1 Credits™ for each
stage that was completed.
Physicians completing, in sequence, all three stages (A – C) of the PI CME activity will be awarded 20 AMA
PRA Category 1 Credits™.
ABIM MOC Credit Statements
This activity is approved through the American Board of Internal Medicine’s (ABIM) Approved
Quality Improvement (AQI) Pathway and is eligible for 10 points towards the Medical Knowledge Selfassessment requirement of Maintenance of Certification (MOC).
This activity is approved through the American Board of Internal Medicine’s (ABIM) Approved
Quality Improvement (AQI) Pathway and is eligible for 20 points towards the Self-Evaluation of
Practice Performance requirement of Maintenance of Certification (MOC).
Partners
American College of Chest Physicians
American Society of Clinical Pathology
The France Foundation
National Institute of Quality Improvement and Education
CECity
Funding
This activity is supported an educational grant provided by Pfizer, Inc.
Questions
For questions regarding PIM content please contact:
cme@chestnet.org
For technical issues please contact:
lifetimesupport@cecitysupport.com