title: Initial experience with a new technique of endoscopic and ultrasonographic access for biopsy of para-aortic (station 6) mediastinal lymph nodes without traversing the aorta.
abstract: OBJECTIVE
  All lymph node stations but the para-aortic are accessible by a combination of endoscopic ultrasound and endobronchial ultrasound. We recently described an echographic-endoscopic technique for the biopsy of para-aortic (station 6) lymph nodes without traversing the thoracic aorta. This study reviewed our initial experience with this new technique.
  
  
  METHODS
  This first-in-human evaluation of the biopsy of station 6 mediastinal lymph nodes with curvilinear endoscopic ultrasound without arterial puncture used a retrospective case series design to study 12 consecutive patients who underwent this new technique. Station 6 lymph nodes were approached with a long fine needle aspiration approach (6-8 cm) through the proximal esophagus. The needle was passed through the esophagus into the mediastinum just medial to the left subclavian artery. It was then directed toward the para-aortic location (6-8 cm trajectory) to reach and enter the para-aortic lymph nodes without piercing the aorta or great vessels.
  
  
  RESULTS
  Successful cytologic diagnoses of station 6 lymph nodes were obtained in all cases (lymphocytes in all samples). No morbidity resulted from the procedure, nor was any observed at 30 days after the procedure. Patient anatomy may preclude safe access in certain situations.
  
  
  CONCLUSIONS
  Endoscopic ultrasound access of para-aortic (station 6) lymph nodes allows complete, minimally invasive mediastinal lymph node staging and diagnosis without traversal of the aorta. This technique, the final piece of the puzzle required for complete staging of the mediastinum with nonsurgical endoscopic techniques, is reproducible and safe.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montréal, Montréal, Québec, Canada. moishe.liberman@umontreal.ca
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: André
authors.initials: A
authors.lastname: Duranceau
authors.forename: Etienne
authors.initials: E
authors.lastname: Grunenwald
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khereba
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
mesh_terms: D001011:Aorta; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011792:Quebec; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed