Technical description of endoscopic ultrasonography with fine-needle aspiration for the staging of lung cancer.
BACKGROUND
Endoscopic ultrasonography (EUS) is a novel method for staging of the mediastinum in lung cancer patients. The recent development of linear scanners enables safe and accurate fine-needle aspiration (FNA) of mediastinal and upper abdominal structures under real-time ultrasound guidance. However, various methods and equipment for mediastinal EUS-FNA are being used throughout the world, and a detailed description of the procedures is lacking. A thorough description of linear EUS-FNA is needed.


METHODS
A step-by-step description of the linear EUS-FNA procedure as performed in our hospital will be provided. Ultrasonographic landmarks will be shown on images. The procedure will be related to published literature, with a systematic literature search.


RESULTS
EUS-FNA is an outpatient procedure under conscious sedation. The typical linear EUS-FNA procedure starts with examination of the retroperitoneal area. After this, systematic scanning of the mediastinum is performed at intervals of 1-2cm. Abnormalities are noted, and FNA of the abnormalities can be performed. Specimens are assessed for cellularity on-site. The entire procedure takes 45-60 min.


CONCLUSIONS
EUS-FNA is minimally invasive, accurate, and fast. Anatomical areas can be reached that are inaccessible for cervical mediastinoscopy. EUS-FNA is useful for the staging of lung cancer or the assessment and diagnosis of abnormalities in the posterior mediastinum.
Kramer
Henk
H
Department of Pulmonary Diseases, University Hospital Groningen, Groningen 9700 RB, The Netherlands. h.kramer@int.azg.nl
van Putten
John W G
JW
Douma
W Rob
WR
Smidt
Alie A
AA
van Dullemen
Hendrik M
HM
Groen
Harry J M
HJ
D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*