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Case Reports
. 2019;97(4):277-283.
doi: 10.1159/000492578. Epub 2018 Sep 25.

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

Ida Skovgaard Christiansen  1   2 , Jolanda Corina Kuijvenhoven  3 , Uffe Bodtger  1   2   4 , Therese Maria Henriette Naur  2   5 , Khaliq Ahmad  2 , Jatinder Singh Sidhu  2 , Rafi Nessar  1 , Goran Nadir Salih  1 , Asbjørn Høegholm  2 , Jouke Tabe Annema  6 , Paul Frost Clementsen  1   4
Affiliations
Case Reports

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

Ida Skovgaard Christiansen et al. Respiration. 2019.

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.

Keywords: Diagnosis; Endobronchial ultrasound; Esophageal ultrasound; Lung cancer.

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Figures

Fig. 1
Fig. 1
A 68-year-old male, with a centrally located left upper lobe tumor located near the esophagus. a PET-CT scan shows FDG uptake in the tumor but not in the hilar and mediastinal lymph nodes. b At conventional bronchoscopy, there were no endobronchial abnormalities and the tumor was not visible with EBUS. c With EUS-B – with the EBUS scope positioned in the flexible esophagus – an inhomogeneous solid-appearing lesion with a close relation to the pulmonary artery was detected. Fine needle aspiration showed an adenocarcinoma of the lung.
Fig. 2
Fig. 2
Flowchart of patients with a centrally located lung tumor who underwent, in a single session, bronchoscopy, EBUS and EUS-B to obtain a diagnosis of the tumor.
See this image and copyright information in PMC

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