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Issa MA, Clementsen PF, Laursen CB, Christiansen IS, Crombag L, Vilmann P, Bodtger U. Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer. Eur Clin Respir J 2024; 11:2362995. [PMID: 38859948 PMCID: PMC11164041 DOI: 10.1080/20018525.2024.2362995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
Background Bronchoscopy and EBUS are standard procedures in lung cancer work-up but have low diagnostic yield in lesions outside the central airways and hilar/mediastinal lymph nodes. Growing evidence on introducing the EBUS endoscope into the oesophagus (EUS-B) in the same session as bronchoscopy/EBUS gives access to new anatomical areas that can be safely biopsied. Objective To summarize the current evidence of the added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in lung cancer work-up. Methods A narrative review. Results Few randomized trials or prospective studies are available. Prospective studies show that add-on EUS-B-FNA increases diagnostic yield when sampling abnormal mediastinal lymph nodes, para-oesophageal lung and left adrenal gland. A large retrospective series on EUS-B-FNA from retroperitoneal lymph nodes suggests high diagnostic yield without safety concerns, as do casuistic reports on EUS-B-FNA from mediastinal pleural thickening, pancreatic lesions, ascites fluid and pericardial effusions. No study has systematically assessed both diagnostic yield, safety, patient reported outcomes, adverse events and costs. Conclusion The diagnostic value of add-on EUS-B to standard bronchoscopy and EBUS in lung cancer work-up appears very promising without safety concerns, giving the pulmonologist access to a variety of sites out of reach with other minimally invasive techniques. Little is known on patient-reported outcomes and costs. Future and prospective research should focus on effectiveness aspects to clarify whether overall benefits of add-on EUS-B sufficiently exceed overall downsides.
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Affiliation(s)
- Mohammad A. Issa
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
| | - Paul F. Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida S. Christiansen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Laurence Crombag
- Department of Respiratory Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Vadala R, Mittal S, Nambirajan A, Hadda V, Mohan A, Guleria R, Madan K. Transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for left adrenal gland (LAG) sampling: A report of three cases with a review of the literature. Lung India 2023; 40:550-554. [PMID: 37961966 PMCID: PMC10723211 DOI: 10.4103/lungindia.lungindia_381_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 11/15/2023] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard-of-care modality for evaluating mediastinal lymph nodes and masses. The EBUS bronchoscope may also be introduced through the oesophageal route to perform sampling of accessible lesions, a technique described as transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). Because of the central oesophageal approach, EUS-B-FNA provides easy access to the left para-tracheal, subcarinal and para-oesophageal lymph nodes. In addition, the left adrenal gland (LAG) can also be imaged and sampled during the EUS-B-FNA procedure. In patients with suspected lung cancer, accurate staging is essential. Adrenal metastasis is relatively common and may often be a solitary metastatic site. We describe three cases where EUS-B-FNA was performed to safely sample the enlarged LAG in suspected lung cancer. We also review the literature on the performance characteristics of EUS-B-FNA for LAG aspiration.
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Affiliation(s)
- Rohit Vadala
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Jeffus S, Quiroga EF, Hasan Z, Fedda F, Meena N, Bartter T. The yield and impact of pulmonologist-performed EUS-B-FNA of subdiaphragmatic lesions-an institutional experience. J Am Soc Cytopathol 2023; 12:362-367. [PMID: 37336683 DOI: 10.1016/j.jasc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Pulmonologists can biopsy structures below the diaphragm using the convex curvilinear ultrasound bronchoscope via the esophagus (EUS-B). The literature with respect to the value of EUS-B, rapid on-site evaluation, and final diagnostic yield for structures below the diaphragm is limited. We review our institutional experience. MATERIALS AND METHODS Our database was queried retrospectively for EUS-B fine needle aspirations (FNAs) from 2013 to 2021. All procedures involving EUS-B-FNA of subdiaphragmatic structures were selected for analysis. The following data elements were collected for each patient: age, gender, clinical indication, sample site, on-site adequacy (OSA), preliminary and final diagnoses, and sufficiency of cell block for ancillary studies. RESULTS A total of 75 subdiaphragmatic sites were biopsied in 74 patients. Of which, 87% of samples subjected to rapid on-site evaluation were deemed to contain adequate material (OSA+). There were no false-positive OSAs. Six cases remained nondiagnostic at the final diagnosis. The final diagnostic yield (with cell block) was 92% (69/75 cases). Cell block was sufficient for immunohistochemistry or special stains in all applicable cases (n = 36). Molecular testing was requested for 11 cases and successful in 10 (91%). Sampling of subdiaphragmatic sites changed the stage in 67% (38/57) of lung cancer patients. CONCLUSIONS Pulmonologists can perform EUS-B-FNA of subdiaphragmatic sites with high OSA and final diagnostic yield when assisted by cytopathologists. Strong correlations exist between OSA, cell block adequacy, and subsequent capacity to perform ancillary testing. EUS-B below the diaphragm can make an important contribution to the diagnosis of lung cancer, nonpulmonary malignancies, and other diseases.
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Affiliation(s)
- Susanne Jeffus
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | | | - Zeinab Hasan
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Faysal Fedda
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nikhil Meena
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Zuccatosta L, Mei F, Bonifazi M, Gasparini S. Historical eye: from traditional to endobronchial ultrasound-guided needle aspiration and beyond. Curr Opin Pulm Med 2023; 29:3-10. [PMID: 36474461 DOI: 10.1097/mcp.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In the history of bronchoscopy, the advent of flexible transbronchial needle aspiration (TBNA) before and, subsequently, of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), have represented fundamental events, as they have significantly and definitively changed interventional pulmonology's role in diagnostic and therapeutic work-up of most of thoracic diseases.Purpose of this historical review is to retrace the main stages that have contributed to the development of these two techniques. RECENT FINDINGS TBNA allowed the bronchoscopists to overcome the barrier of the tracheobronchial wall and to obtain samples from hilar-mediastinal lesions. With this additional method, bronchoscopy has become an essential procedure for staging of lung cancer.The advent of echo-bronchoscopes, allowing to perform TBNA under direct ultrasound guidance in real time, further increased the diagnostic yield of this technique. Furthermore, the insertion of the echo-bronchoscope through the oesophagus allowed to extend the landscape of targets to sample, including also para-esophageal lesions, liver metastases, celiac nodes and left adrenal glands.EBUS-TBNA has shown its usefulness not only in the approach to mediastinal lesions, but also in other clinical conditions, such as lung nodules or masses adjacent to the tracheobronchial tree. SUMMARY Despite the obvious advantages of EBUS-TBNA, this technology is not yet available in many centres and countries worldwide. For this reason, TBNA remains a basic technique that must complete the technical background of bronchoscopists and it should not be forgotten.
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Affiliation(s)
- Lina Zuccatosta
- Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti'
| | - Federico Mei
- Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti'
- Department of Biomedical Science and Public Health, Polytechnic University of Marche Region, Ancona, Italy
| | - Martina Bonifazi
- Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti'
- Department of Biomedical Science and Public Health, Polytechnic University of Marche Region, Ancona, Italy
| | - Stefano Gasparini
- Pulmonary Diseases Unit, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti'
- Department of Biomedical Science and Public Health, Polytechnic University of Marche Region, Ancona, Italy
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Alıcı İO, Aydoğdu Z. EUS-B-FNA for Left Adrenal Lesions in Non-Small Cell Lung Cancer Patients: Report of Cases and Literature Review. Turk Thorac J 2019; 21:209-212. [PMID: 32584239 DOI: 10.5152/turkthoracj.2019.190109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
Abstract
The left adrenal gland (LAG) is a common metastatic site in patients with non-small-cell lung cancer. In practice, staging mainly relies on radiologic studies and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Recently, a new technique using convex probe-endobronchial ultrasound (CP-EBUS) scope through the esophagus (EUS-B) has been introduced. A complete mediastinal staging and a reach for upper-abdominal structures in a single session naturally attract attention. However, scientific data are not sufficient to clearly judge the role of this technique in the cytological diagnosis of left adrenal lesions. Therefore, we present cases in which our patients have undergone EUS-B for LAG lesions to increase the data in the literature with regard to accessibility, diagnostic performance, and rate of complications.
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Affiliation(s)
- İbrahim Onur Alıcı
- Department of Pulmonary Medicine, Dr. Suat Seren Training and Research Hospital for Pulmonary Diseases and Thoracic Surgery, İzmir, Turkey
| | - Zekiye Aydoğdu
- Department of Pathology, Dr. Suat Seren Training and Research Hospital for Pulmonary Diseases and Thoracic Surgery, İzmir, Turkey
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Soo CI, Kho SS, Ng BH, Tie ST. Endobronchial and endoscopic ultrasound: it only takes an echobronchoscope to tango. Respirol Case Rep 2019; 7:e00482. [PMID: 31467678 PMCID: PMC6711354 DOI: 10.1002/rcr2.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022] Open
Abstract
Endobronchial ultrasound (EBUS) is indispensable when it comes to evaluation of mediastinal lesion and staging of lung cancer. The incorporation of endoscopic ultrasound using an echobronchoscope (EUS-B) further extends this capability to the paraoesophageal and subdiaphragmatic structures. When combined, EBUS with EUS-B increases the diagnostic yield. Both procedures can be done in a single session and by a single operator; this translates into an overall reduction in the healthcare cost.
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Affiliation(s)
- Chun Ian Soo
- Pulmonology Unit, Department of Internal MedicineNational University of Malaysia (UKM) Medical CentreKuala LumpurMalaysia
| | - Sze Shyang Kho
- Division of Respiratory Medicine, Department of Internal MedicineSarawak General Hospital, Ministry of HealthKuchingSarawakMalaysia
| | - Boon Hau Ng
- Pulmonology Unit, Department of Internal MedicineNational University of Malaysia (UKM) Medical CentreKuala LumpurMalaysia
| | - Siew Teck Tie
- Division of Respiratory Medicine, Department of Internal MedicineSarawak General Hospital, Ministry of HealthKuchingSarawakMalaysia
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Darwiche K, Becker J, Winantea J, Karpf-Wissel R, Funke F, Stenzel E, Hautzel H, Hager T, Eisenmann S. Integration of Bronchoscopic Transesophageal Ultrasound Examination of the Left Adrenal Gland into Routine Lung Cancer Staging Workup: A Prospective Trial. Respiration 2019; 99:43-49. [PMID: 31618731 DOI: 10.1159/000503396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) with transbronchial needle aspiration increases the diagnostic yield of lung cancer staging. The left adrenal gland (LAG) is a common site for lung cancer metastasis. The modality of transesophageal examination with an EBUS bronchoscope (EUS-B) routinely for LAG has not been assessed. OBJECTIVE The aim of this study was to prospectively assess if evaluation and tissue sampling of the LAG could routinely be implemented in an EBUS procedure. METHODS Patients referred for EBUS between March and August 2017 had assessment of the LAG via EUS-B. Fine-needle aspiration (FNA) was performed in cases with a suspicious LAG. The detection rate, procedure time, and learning curve of four experienced EBUS-bronchoscopists was assessed, plus the diagnostic accuracy and complication rate of FNA. RESULTS In total, 313 consecutive patients were included. The overall LAG detection rate was 87.5%. After the initial learning curve, the detection rate for all four bronchoscopists was >93%. The detection rate did not correlate with any patient characteristics. EUS-B-FNA revealed nine LAG metastases, with a sensitivity, specificity, and accuracy of 75%, 100%, and 99%, respectively. The mean EUS-B operation time was 194.4 s, with 594.8 s for FNA. There were no FNA-associated complications. CONCLUSIONS Evaluation of the LAG with EUS-B could routinely be included in an EBUS procedure if necessary. A high detection rate can be achieved after an initial learning period. FNA of the LAG was feasible and safe. EUS-B of the LAG could be integrated into the usual EBUS/EUS-B procedure in lung cancer staging workup.
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Affiliation(s)
- Kaid Darwiche
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany,
| | - Jonathan Becker
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Jane Winantea
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Ruediger Karpf-Wissel
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Faustina Funke
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Elena Stenzel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Hager
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stephan Eisenmann
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany.,Department of Pneumology, University Hospital of Martin Luther University, Halle (Saale), Germany
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8
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Cocciardi S, Borah A, Terrigno R, Abouzgheib W, Boujaoude Z. A case report of an expensive yet necessary thoracentesis: Expanding the boundaries of endoscopic ultrasound transbronchial needle aspiration. Medicine (Baltimore) 2019; 98:e17555. [PMID: 31593139 PMCID: PMC6799771 DOI: 10.1097/md.0000000000017555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS). PATIENT CONCERNS 52-year-old women with dyspnea, fever and a new loculated pleural effusion that was suspected to be the source of the fever but was not accessible through traditional thoracentesis. DIAGNOSIS Malignant pleural effusion. INTERVENTIONS Sampling and drainage of the loculated pleural fluid collection using EBUS scope introduced via the esophagus. OUTCOMES Infection excluded. Resolution of fever and improved dyspnea after drainage of effusion. LESSONS The convex curvilinear ultrasound bronchoscope allows unprecedented access to thoracic structures. The reach is not limited to mediastinal lymph nodes and parenchymal masses adjacent to the airways, and pleural space and pleural fluid are at times accessible, particularly when one considers the esophageal approach.
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9
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Novotny AG, Reynolds JP, Shah AA, Bhatt A, Chahal P, Remer EM, Stevens T, Gmitro S, Sturgis CD. Fine‐needle aspiration of adrenal lesions: A 20‐year single institution experience with comparison of percutaneous and endoscopic ultrasound guided approaches. Diagn Cytopathol 2019; 47:986-992. [DOI: 10.1002/dc.24261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Aaron G. Novotny
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Jordan P. Reynolds
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Akeesha A. Shah
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Amit Bhatt
- Department of GastroenterologyCleveland Clinic Cleveland Ohio
| | | | | | - Tyler Stevens
- Department of GastroenterologyCleveland Clinic Cleveland Ohio
| | - Stephen Gmitro
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Charles D. Sturgis
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
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Sehgal IS, Agarwal R, Dhooria S, Prasad KT, Aggarwal AN. Role of EBUS TBNA in Staging of Lung Cancer: A Clinician's Perspective. J Cytol 2019; 36:61-64. [PMID: 30745743 PMCID: PMC6343401 DOI: 10.4103/joc.joc_172_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The treatment of non-small cell lung cancer (NSCLC) includes surgical resection with curative intent in early-stage disease and chemoradiation in the advanced stage disease. Therefore, an accurate preoperative mediastinal lymph node staging is required not only to offer the appropriate treatment but also to avoid unnecessary invasive procedures including thoracotomy. The mediastinal lymph nodes can be sampled using several techniques including mediastinoscopy, surgery (open or video-assisted thoracoscopic surgery), endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), or endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA). Currently, EBUS-TBNA/EUS-FNA is the preferred modality for sampling mediastinal lymph nodes because of its minimally invasive nature and high diagnostic yield. In this review, we discuss the utility of endosonographic procedures in mediastinal lymph node staging of NSCLC.
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Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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11
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Tamburrini M, Gothi D, Barbetta C, Del Conte A, Sulfaro S, Zuccon U. Esophageal ultrasound with ultrasound bronchoscope (EUS-B) guided left adrenal biopsy: Case report with review of literature. Respir Med Case Rep 2018; 26:154-156. [PMID: 30603608 PMCID: PMC6310773 DOI: 10.1016/j.rmcr.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022] Open
Abstract
A 45-year old man, chronic smoker with a pancoast tumor due to squamous cell carcinoma has been described. The initial diagnosis of lung carcinoma was based on a scant tissue so the exact cell typing was not possible. The initial treatment consisted of platinum based chemotherapy and radiotherapy. He developed a left adrenal lesion on treatment. There was a possibility of metachronous primary. Also, a large tissue sample was required for tumor markers. The lung mass was difficult to access and was static on treatment. A left adrenal biopsy was considered to be more appropriate. A novel approach for left adrenal lesion with esophageal ultrasound using ultrasound bronchoscope (EUS-B) was successfully performed. This article is aimed at describing the use of EUS-B for transdiaphragmatic structures.
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Affiliation(s)
- Mario Tamburrini
- Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy
| | - Dipti Gothi
- Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India
| | - Carlo Barbetta
- Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy
| | | | - Sandro Sulfaro
- Department of Pathology, Santa Maria degli Angeli di Pordenone, Italy
| | - Umberto Zuccon
- Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy
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12
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Wimaleswaran H, Farmer MW, Irving LB, Jennings BR, Steinfort DP. Pulmonologist-performed transoesophageal sampling for lung cancer staging using an endobronchial ultrasound video-bronchoscope: an Australian experience. Intern Med J 2017; 47:205-210. [PMID: 27860078 DOI: 10.1111/imj.13330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/16/2016] [Accepted: 11/03/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transoesophageal endobronchial ultrasound (EBUS) video-bronchoscope insertion provides pulmonologists access to conduct endoscopic fine-needle aspiration (EUS-B-FNA) of mediastinal lymph node (LN) lesions and also assist in lung cancer staging by sampling left adrenal gland (LAG) lesions. Limited literature has described additional diagnostic value whilst maintaining patient safety. To elicit whether combining endoscopic transoesophageal fine-needle aspiration using convex probe bronchoscope (EUS-B-FNA) and EBUS bronchoscopy enhances the diagnostic yield of mediastinal nodal staging in lung cancer, whilst maintaining safety. METHODS All eligible patients with paraoesophageal lesions on thoracic computed tomography (CT) underwent pulmonologist-performed EUS-B-FNA at two tertiary centres and were included in this prospective observational cohort study. RESULTS EUS-B-FNA sampling was performed at 69 mediastinal LN lesion sites, including 17 sites inaccessible to bronchoscopic sampling. Four LAG lesions were sampled via EUS-B-FNA. There were no complications. EBUS-TBNA was augmented by EUS-B-FNA because of accessibility of sampling lesions otherwise unamenable bronchoscopically, thereby increasing diagnostic utility. Diagnostic sensitivity of EUS-B-FNA for malignancy in mediastinal LN lesions was 88% (51 of 58). For mediastinal LN lesions not amenable to EBUS-TBNA, the sensitivity for diagnosis of malignancy via EUS-B-FNA was 88% (15 of 17). Diagnostic sensitivity of EUS-B-FNA for malignancy in LAG lesions was 50% (2 of 4). CONCLUSION EUS-B-FNA is a precise and safe approach in the evaluation and staging of lung cancer when performed by a pulmonologist. It complements and increases the diagnostic utility of EBUS-TBNA by further coverage of mediastinal LN stations and access to LAG lesions.
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Affiliation(s)
- Hari Wimaleswaran
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael W Farmer
- Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louis B Irving
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Barton R Jennings
- Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Daniel P Steinfort
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Sanz-Santos J, Serra P, Andreo F, Torky M, Centeno C, Morán T, Carcereny E, Fernández E, García-Reina S, Ruiz-Manzano J. Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer. BMC Pulm Med 2017; 17:46. [PMID: 28241873 PMCID: PMC5330131 DOI: 10.1186/s12890-017-0388-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/22/2017] [Indexed: 12/18/2022] Open
Abstract
Background The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. Methods We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Results Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. Conclusions EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.
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Affiliation(s)
- José Sanz-Santos
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain.
| | - Pere Serra
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain.,Department de Medicina. Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Felipe Andreo
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
| | - Mohamed Torky
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
| | - Carmen Centeno
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
| | - Teresa Morán
- Catalan Institute of Oncology, Badalona, Barcelona, Spain
| | - Enric Carcereny
- Thoracic Surgery Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esther Fernández
- Thoracic Surgery Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Samuel García-Reina
- Thoracic Surgery Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Ruiz-Manzano
- Pulmonology Department, Hospital Germans Trias i Pujol, Carretera de Canyet S/N. 08916, Badalona, Barcelona, Spain
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Abstract
INTRODUCTION In patients with lung cancer, left adrenal glands (LAG) suspected for distant metastases (M1b) based on imaging require further evaluation for a definitive diagnosis. Tissue acquisition is regularly performed using conventional EUS-FNA. The aim of this study was to investigate the success rate of endoscopic ultrasound guided fine-needle aspiration using the EBUS scope (EUS-B-FNA) for LAG analysis. METHODS This is a prospective multicenter study in consecutive patients with (suspected) lung cancer and suspected mediastinal and LAG metastases. Following complete mediastinal staging using the EBUS scope (EBUS+EUS-B), the LAG was evaluated and sampled by both EUS-B (experimental procedure) and conventional EUS (current standard of care). RESULTS The success rate for LAG analysis (visualized, sampled and adequate tissue obtained) was 89% (39/44; 95% CI 76-95%) for EUS-B-FNA, and 93% (41/44; 95%CI 82-98%) for EUS-FNA. In the absence of metastases at EUS-B and/or EUS, surgical verification of the LAG or 6 months clinical and radiological follow-up was obtained, but missing for 5 patients. The prevalence of LAG metastases was 54% (21/39). In patients in whom LAG was seen and sampled, sensitivity for LAG metastases was at least 87% (95%CI 65-97%) for EUS-B, and at least 83% (95%CI 62-95%) for conventional EUS. CONCLUSION LAG analysis by EUS-B shows a similar high success rate in comparison to conventional EUS. IMPLICATION Both a mediastinal nodal and LAG evaluation can be adequately performed with just an EBUS scope and single endoscopist. This staging strategy is likely to reduce patient-burden and costs.
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15
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Meena N, Hulett C, Patolia S, Bartter T. Exploration under the dome: Esophageal ultrasound with the ultrasound bronchoscope is indispensible. Endosc Ultrasound 2016; 5:254-7. [PMID: 27503158 PMCID: PMC4989407 DOI: 10.4103/2303-9027.187886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes. Methods: After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis. Results: Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications. Conclusions: Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure.
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Affiliation(s)
- Nikhil Meena
- Department of Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, AR, USA
| | - Cidney Hulett
- Department of Internal Medicine, CHI St. Vincent Infirmary, Little Rock, AR, USA
| | - Setu Patolia
- Department of Internal Medicine, St. Louis University, St. Louis, MO, USA
| | - Thaddeus Bartter
- Department of Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, AR, USA
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Crombag LMMJ, Annema JT. Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial. Respiration 2016; 91:235-40. [PMID: 26930053 DOI: 10.1159/000443991] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In lung cancer patients, the adrenal glands are predilection sites for distant metastases. Esophageal endoscopic ultrasound - fine-needle aspiration (EUS-FNA) is a minimally invasive and accurate method for left adrenal gland (LAG) analysis but requires a conventional gastrointestinal echoendoscope. Complete endobronchial and esophageal mediastinal nodal staging can be achieved by just a single endobronchial ultrasound (EBUS) scope, introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. OBJECTIVES The aim of the study was to investigate the feasibility of identifying the LAG with the EBUS scope. METHODS We conducted a retrospective analysis of lung cancer patients who underwent EBUS and EUS-B for mediastinal staging and LAG assessment between January 2013 and May 2015. RESULTS A total of 143 patients with (suspected) lung cancer were investigated by the combination of EBUS and EUS-B. In 68 of the 80 patients (85%) in whom an attempt was made to identify the LAG, it was feasible to transgastrically detect the LAG with the EBUS scope. In 9 patients with endosonographic signs of malignant involvement, diagnostic transgastric FNAs were obtained in all. In the 12 patients (15%) in whom the LAG was not detected, the contact between the ultrasound transducer and the gastric wall was suboptimal - the length of the scope was not a limiting factor. CONCLUSIONS The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. IMPLICATION In patients with (suspected) lung cancer, in addition to complete hilar and mediastinal staging, LAG assessment using just a single EBUS scope also seems feasible. Prospective studies are indicated.
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Affiliation(s)
- Laurence M M J Crombag
- Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Meena N, Abouzgheib W, Aboujaoude Z, Bartter T. Endosonography: esophagus is better! Chest 2015; 148:e129. [PMID: 26437824 DOI: 10.1378/chest.15-1262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nikhil Meena
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR.
| | - Wissam Abouzgheib
- Division of Pulmonary and Critical Care, Department of Internal Medicine Cooper University Hospital, Cooper University Health Care, Camden, NJ
| | - Ziad Aboujaoude
- Division of Pulmonary and Critical Care, Department of Internal Medicine Cooper University Hospital, Cooper University Health Care, Camden, NJ
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR
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Gasparini S, Bonifazi M. Bronchoscope: beyond the thorax! ACTA ACUST UNITED AC 2015; 89:17-8. [PMID: 25592827 DOI: 10.1159/000370127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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