Endobronchial Ultrasound Application for Diagnosis of Tracheobronchial Tree Invasion by Esophageal Cancer

Abstract

INTRODUCTION: Esophageal cancer staging has been performed through bronchoscopy, computerized tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS). Whereas CT and PET scan provide assessments of distant metastasis, bronchoscopy importantly diagnoses tracheobronchial involvement, complementing chest CT findings. EUS is the most accurate examination for T and N staging but is technically limited when tumoral stenoses cannot be traversed. Endobronchial ultrasound (EBUS) appears to present greater accuracy than EUS, CT, and bronchoscopy for assessing tracheobronchial wall involvement. EBUS has been recently associated with EUS for esophageal cancer staging in our unit. OBJECTIVE: To compare EBUS findings in esophageal cancer patients without evident signs of tracheobronchial invasion on conventional bronchoscopy with EUS and CT. METHODS: Fourteen patients with esophageal cancer underwent CT, conventional bronchoscopy, EUS, and EBUS for preoperative staging. All patients underwent EBUS and EUS with an Olympus® MH-908 echoendoscope at 7.5 MHz. Seven patients were eligible for the study according to the inclusion criteria. RESULTS: The echoendoscope could not traverse tumoral esophageal stenosis to perform EUS in two patients, and invasion was effectively diagnosed by EBUS. In 4 (57%) of 7 patients EBUS revealed additional information to staging. In the remaining 3 cases the invasion findings were the same under both EUS and EBUS. CONCLUSION: EBUS showed signs of tracheobronchial invasion not observed by conventional bronchoscopy, adding information to staging in most of the cases when compared with CT and EUS

Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer

“…As circumstantial evidence, all 94 patients who were diagnosed as negative for a tracheobronchial tree invasion by EBUS demonstrated no invasion of the trachea, as observed during radical surgery. Because of the interference by air and the narrow space between the trachea and the esophagus, EUS has less sensitivity in the diagnosis of esophageal cancer that has invaded the tracheobronchial tree [ 16 ]. Our observations indicate that EBUS may be an additional complement in the preoperative exclusion of patients with tracheal invasion, especially in the case of esophageal stricture.…”

Unique application of awake tracheoscopy and endobronchial ultrasound in the management of tracheal mucoepidermoid carcinoma

“…Radial‐probe endobronchial ultrasound can characterize lumen wall invasion, and when combined with esophageal ultrasound, it can also identify mediastinal lymph node involvement with high sensitivity. Several studies have affirmed the use of radial‐probe‐endobronchial ultrasound in the evaluation of external tracheobronchial invasion from esophageal and thyroid cancers; the sensitivity and specificity of endobronchial ultrasound exceeds that of bronchoscopy, esophageal ultrasound, CT, and MRI . After initial palliative resection, we utilized this imaging modality for evaluation of invasion in the outward direction (from within the trachea to the outer tracheal wall).…”

Endobronchial ultrasound in esophageal cancer - when upper gastrointestinal endoscopy is not enough

“… 3 , 4 However, patients with esophageal cancer often present with few or no symptoms; dysphagia occurs only when two thirds of the esophageal lumen are involved, which is why diagnosis is often delayed and prognosis is poor. 3 - 5 …”

“… 4 However, EUS-FNA probes are typically large and can therefore be a problem in the presence of a malignant stricture. 4 In addition, although local extension to lymph nodes and esophageal wall invasion are best investigated by EUS-FNA, 2 , 4 narrowing of the esophageal lumen can prevent the progression of the endoscope in up to 30% of cases, 5 constituting an obstacle to diagnosis and staging by preventing the collection of representative biopsy material through the esophageal lumen. In such cases, EBUS-TBNA can be performed either through the esophagus (because EBUS-TBNA probes are smaller in diameter) or through the tracheobronchial tree, constituting an alternative approach.…”

“…In such cases, EBUS-TBNA can be performed either through the esophagus (because EBUS-TBNA probes are smaller in diameter) or through the tracheobronchial tree, constituting an alternative approach. 2 , 5 …”