Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions

Abstract

Background: Diagnosing centrally located lung tumors without endobronchial abnormalities and not located near the major airways is a diagnostic challenge. Tumors near or adjacent to the esophagus can be aspirated and detected with esophageal ultrasound (EUS) using gastrointestinal endoscopes. Objective: To assess the feasibility and diagnostic yield of endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) in paraesophageally located lung tumors and its added value to bronchoscopy and endobronchial ultrasound (EBUS). Methods: Retrospective, multicenter international study (from January 1, 2015 until January 1, 2018) of patients with suspected lung cancer, undergoing bronchoscopy, EBUS, and endoscopic ultrasound bronchoscopy (EUS-B) in one session by a single operator (pulmonologist), in whom the primary lung tumor was detected and aspirated by EUS-B. In the absence of malignancy following endoscopy, transthoracic ultrasound needle aspiration, clinical and radiological follow-up of at least 6 months was performed. The yield and sensitivity of EUS-B-FNA and its added value to bronchoscopy and EBUS was assessed. Results: 58 patients were identified with the following diagnosis: non-small-cell lung cancer (n = 43), small-cell lung cancer (n = 6), mesothelioma (n = 2), metastasis (n = 1), nonmalignant (n = 6). The yield and sensitivity of EUS-B-FNA for detecting lung cancer was 90%. In 26 patients (45%), the intrapulmonary tumor was exclusively detected by EUS-B. Adding EUS-B to conventional bronchoscopy and EBUS increased the diagnostic yield for diagnosing lung cancer in para­esophageally located lung tumors from 51 to 91%. No EUS-B-related complications were observed. Conclusion: EUS-B-FNA is a feasible and safe technique for diagnosing centrally located intrapulmonary tumors that are located near or adjacent to the esophagus. EUS-B should be considered in the same endoscopy session following nondiagnostic bronchoscopy and EBUS.

Endobronchial and endoscopic ultrasound: it only takes an echobronchoscope to tango

“…Another advantage of EUS‐B is that it provides access for evaluation of mediastinal lesions adjacent to the oesophagus. Novel usage of EUS‐B for the diagnosis of centrally located intrapulmonary lesions has been described . Two studies employing EUS‐B demonstrated a similar diagnostic yield of approximately 90% sensitivity and were comparable to conventional EUS for the diagnosis of intrapulmonary tumours; there were no reported complications .…”

“…Novel usage of EUS‐B for the diagnosis of centrally located intrapulmonary lesions has been described . Two studies employing EUS‐B demonstrated a similar diagnostic yield of approximately 90% sensitivity and were comparable to conventional EUS for the diagnosis of intrapulmonary tumours; there were no reported complications . A notable finding was that 45% of cases were diagnosed using only the transoesophageal approach with EUS‐B .…”

“…Compared to its use with peripherally located lesions, CT‐guided aspiration of central lesions can be technically more challenging. In addition, assessment of central lesions by EUS‐B precludes potential complications, such as bleeding, iatrogenic injury to the surrounding organs, and, importantly, pneumothoraces attributed to radiologically guided sampling of centrally located mediastinal or pulmonary lesions . Invasive surgical staging can then be used as a reserved option for suspicious cases that failed endoscopic sampling.…”

Re-biopsy after first line treatment in advanced NSCLC can reveal changes in PD-L1 expression

“…Transthoracic sampling from lung lesions is performed guided by Ultra Sound (US), fluoroscopy or CT, and percutaneous non-lung lesions (e.g. peripheral lymph nodes, liver, spleen, skin) are reached by US-guided biopsy [5][6][7][8]. Whenever possible, histological biopsies were obtained (e.g.…”

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of paraesophageal lung tumors – diagnostic yield and added value

“…There are very few studies including patients with previous non-diagnostic bronchoscopy that underwent EUS-FNA addressed to paraesophageal lung tumors [9,10] and few lung EUS-FNA studies included patients having either a negative bronchoscopy or a negative CT-guided biopsy [13][14][15][16]. A recent study supports the added value of EUS-FNA after a non-diagnostic bronchoscopy, showing an increase of the diagnostic yield from 51 to 91% [17].…”