Transesophageal approach to lung, adrenal biopsy and fiducial placement using endoscopic ultrasonography (EUS): An interventional pulmonology experience. Initial experience of the UCSF-FRETOC (fresno tracheobronchial & oesophageal center) study group. (August 2018)

• Record Type: Journal Article
• Authors: Pais, Faye M.; Shah, Raj A.; Vempilly, Jose J.; Gullapalli, Sneha; Upadhyay, Daya; Peterson, Michael; Liberman, Moishe; Hegde, Pravachan
• Is Part Of: Respiratory medicine. Volume 141(2018)
• Page Start: 52
• Page End: 55
• Publication Date: 2018-08
• Subjects: Lung cancer -- Diagnostic techniques and procedures -- Cancer staging -- Stereotactic body radiotherapy -- Interventional pulmonology; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2018.06.019
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Routine lung cancer surveillance has resulted in early detection of pulmonary nodules and masses. Combined endobronchial ultrasound (EBUS) and trans -esophageal endoscopic ultrasound (EUS) are approved methods for sampling lymph nodes or masses. Furthermore, EUS allows for adrenal sampling as part of staging, and can assist with fiducial placement for stereotactic body radiation therapy (SBRT). Objectives: Promote use of EUS by interventional pulmonologists in the United States when diagnosing and staging lung cancer or when placing fiducials. Methods: All patients undergoing EUS and/or EBUS were serially entered into a prospectively maintained database. Only patients undergoing EUS guided lung and/or adrenal biopsy and/or fiducial placement were selected for analysis. All patients underwent a post-procedure chest radiograph and were followed outpatient. Results: 20 of 39 patients underwent sampling of a suspicious lung mass. An adequate sample was obtained in 19 of 20 patients. In all 19 patients a definitive diagnosis was achieved (95%). In all 13 patients who underwent adrenal sampling, presence or absence of metastasis was conclusively established. 6 patients successfully underwent fiducial placement. In all 39 patients, no major procedure related complications were noted for a period of 30 days. One patient had a small pneumothorax that resolved spontaneously. Conclusions: EUS can be safely performed by a trained interventional pulmonologist for the diagnosis of lung, adrenal masses and placement of fiducials. We think that interventional pulmonologists in the United States involved in lung cancer staging should receive training in EUS techniques. Highlights: Endoesophageal ultrasonography is beneficial in diagnosis & staging of lung cancer. EUS can reach lower lobes that may be difficult with Endobronchial ultrasound. EUS can also biopsy adrenal nodules to determine if metastasis is present. EUS can be used to place fiducials for targeted radiotherapy. Interventional pulmonologists should consider training in EUS techniques.