肺結節に対するEBUS-GSや、縦隔リンパ節に対する EBUS-TBNAなど、EBUS（endobronchial ultrasound）は無くてはならないものになっていると思います。

でも実際にEBUSをうまく使いこなせているかどうか、質の評価はどのようにすれば良いでしょう？また、検査のレポートにはどのような項目を書くと良いでしょうか？これらに関してステートメントが出ています。

Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement

Steinfort DP, Evison M, Witt A, et al. Respirology. 2023;28(8):722-743.

Background: Since their introduction, both linear and radial endobronchial ultrasound (EBUS) have become an integral component of the practice of Pulmonology and Thoracic Oncology. The quality of health care can be measured by comparing the performance of an individual or a health service with an ideal threshold or benchmark. The taskforce sought to evaluate quality indicators in EBUS bronchoscopy based on clinical relevance/importance and on the basis that observed significant variation in outcomes indicates potential for improvement in health care outcomes.

Methods: A comprehensive literature review informed the composition of a comprehensive list of candidate quality indicators in EBUS. A multiple-round modified Delphi consensus process was subsequently performed with the aim of reaching consensus over a final list of quality indicators and performance targets for these indicators. Standard reporting items were developed, with a strong preference for items where evidence demonstrates a relationship with quality indicator outcomes.

Results: Twelve quality Indicators are proposed, with performance targets supported by evidence from the literature. Standardized reporting items for both radial and linear EBUS are recommended, with evidence supporting their utility in assessing procedural outcomes presented.

Conclusion: This statement is intended to provide a framework for individual proceduralists to assess the quality of EBUS they provide their patients through the identification of clinically relevant, feasible quality measures. Emphasis is placed on outcome measures, with a preference for consistent terminology to allow communication and benchmarking between centres.

PMID: 37463832

下記のような項目をレポートに記載することが推奨されていました。

  • 検査前：適応、術者・助手の名前、肺がん疑いならclinical stage（TNM）、病変のサイズ・部位、オプションでbronchus signの有無と結節の性状（solid, subsolid, ground glass）
  • 検査中：ROSEの有無、linear EBUS（≒ EBUS-TBNA）ではFujiwara, et al. Chest 2010. に準じた所見（size, shape, margin, echogenicity, hilar structures）とTBNAのゲージ、radial EBUSではプローブポジション（within/adjacent）とサンプリング方法・数
  • 検査後：合併症と対応

それぞれのQI（quality indicator）について目標が設定されているのが良いですね。ぜひ自施設のQIをモニタリングしてKAIZENの余地がないか確認してみて下さい。