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

Our plain-English summary of Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions, by I. Skovgaard Christiansen, J.C. Kuijvenhoven, U. Bodtger, et al (Respiration; International Review of Thoracic Diseases, 2019).

The study

• Authors: I. Skovgaard Christiansen, J.C. Kuijvenhoven, U. Bodtger, T.M.H. Naur, K. Ahmad, J. Singh Sidhu, R. Nessar, G.N. Salih, A. Høegholm, J.T. Annema, P.F. Clementsen
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2019;97(4):277-283
• Type of article: Case report
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

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 para-esophageally 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.

© 2018 The Author(s) Published by S. Karger AG, Basel.

In plain English

This retrospective study, from three hospitals in Denmark and the Netherlands, looked at a lung-examination technique. Doctors passed an ultrasound bronchoscope down the food pipe and drew samples, through a needle, from suspected lung tumors lying next to the esophagus. The study covered 2015 to 2018 and included 58 patients with suspected lung cancer. Final diagnoses were non-small-cell lung cancer (43), small-cell lung cancer (6), malignant mesothelioma (2), spread from another cancer (1) and nonmalignant conditions (6). The article does not discuss asbestos. The technique on its own gave a diagnosis in 90% of patients (52 of 58). In 26 patients (45%) it was the only method that found and sampled the tumor. The usual airway examinations gave a diagnosis in 51% (27 of 53); adding the new technique raised this to 91% (53 of 58). No complications from the technique were recorded. The authors concluded it is feasible and safe and should be considered in the same session after non-diagnostic airway examinations. They noted strong patient-selection bias and that the operators were experts.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective multicenter international study of a diagnostic procedure (EUS-B-FNA)
• Who was studied: 58 patients with suspected lung cancer who underwent EUS-B-FNA of an intrapulmonary lesion at three hospitals (Naestved and Roskilde, Denmark; Amsterdam, the Netherlands), January 1, 2015 to January 1, 2018; 34 female (59%), median age 78 years
• Exposure: No asbestos or fiber exposure was studied. The subject was a diagnostic procedure: needle aspiration of lung tumors through the esophagus using an EBUS (ultrasound bronchoscope) endoscope, with a 21-G or 22-G needle
• Main results:
  • Final diagnoses among the 58 patients included malignant mesothelioma in 2 patients. The others were NSCLC 43, SCLC 6, metastasis 1 and nonmalignant 6
  • Diagnostic yield of EUS-B alone was 90% (52 of 58 patients)
  • In 26 patients (45%), the tumor was found and sampled only with EUS-B-FNA
  • Bronchoscopy plus EBUS gave a diagnostic yield of 51% (27 of 53 patients). Adding EUS-B gave a combined yield of 91% (53 of 58 patients)
  • Sensitivity of EUS-B for diagnosing any malignancy was 90%; the authors describe the population as very selected
  • Of the 58 samples, 55 (95%) were adequate for cytopathological evaluation
  • No EUS-B-related complications were recorded
• The authors' conclusion: The authors concluded that EUS-B-FNA is feasible and safe for diagnosing central lung tumors near or next to the esophagus. They added that it should be considered in the same session after non-diagnostic bronchoscopy and EBUS.
• Limitations the authors state:
  • The retrospective design means a large patient-selection bias
  • All three centers had expert EUS-B operators; it is unclear whether less experienced doctors would achieve similar results
  • The technique works only for tumors near or next to the esophagus, and the maximum usable distance is unknown

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Ultrasound, Bronchoscopy, Lung Cancer, Endoscopy, Mesothelioma, Metastasis.

Related studies

• Endoscopic ultrasound-guided fine needle aspiration of a pericardial mass — P. Somani, M. Sharma, et al. (2016)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Isolated pancreatic metastasis from a malignant pleural mesothelioma diagnosed using endoscopic ultrasonography-guided fine needle aspiration biopsy — Y. Ishikawa-Kakiya, H. Maruyama, et al. (2022)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Pseudomesotheliomatous carcinoma of lung adenocarcinoma diagnosed using transesophageal ultrasound-guided bronchoscopic aspiration — T. Sumi, H. Nakata, et al. (2021)

Browse more research in Respiration; International Review of Thoracic Diseases, or return to medical research.