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Review
. 2024 Jun 9;11(1):2362995.
doi: 10.1080/20018525.2024.2362995. eCollection 2024.

Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer

Mohammad A Issa  1 , Paul F Clementsen  1   2 , Christian B Laursen  3   4 , Ida S Christiansen  1   5 , Laurence Crombag  6 , Peter Vilmann  7   8 , Uffe Bodtger  1   9
Affiliations
Review

Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer

Mohammad A Issa et al. Eur Clin Respir J. .

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.

Keywords: EBUS; EUS-B; Lung cancer; bronchoscopy; diagnosis; staging.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Image of the EUS echo-endoscope (a) and the EBUS echo-endoscope (b).
Figure 2.
Figure 2.
Overview of structures that can be reached by EBUS, EUS/EUS-B or both.
Figure 3.
Figure 3.
EUS-B image of mediastinal lymph node station 7.
Figure 4.
Figure 4.
EUS-B image of mediastinal lymph node station 4 R.
Figure 5.
Figure 5.
EUS-B image of mediastinal lymph node station 4 L.
Figure 6.
Figure 6.
EUS-B image of mediastinal lymph node station 8.
Figure 7.
Figure 7.
EUS-B image of a lung tumor in the left upper lobe being biopsied.
Figure 8.
Figure 8.
EUS-B image of the liver.
Figure 9.
Figure 9.
EUS-B image of the left adrenal gland.
Figure 10.
Figure 10.
EUS-B image of a retroperitoneal lymph node being biopsied.
Figure 11.
Figure 11.
EUS-B image of a pericardial effusion.
See this image and copyright information in PMC

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