title: Linear endobronchial and endoesophageal ultrasound: a practice change in thoracic medicine.
abstract: OBJECTIVE
  Linear endosonography, including intrathoracic lymph nodal sampling by endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and endoesophageal ultrasound fine-needle aspiration (EUS-FNA), has an important role in the diagnosing and staging of lung cancer. Furthermore, endosonography is applied in the mediastinal evaluation of sarcoidosis, lymphoma, cysts, and nodal metastases of extrathoracic malignancies. Endosonography-related complications as well as sedation and training strategies are discussed. The purpose of this review is to summarize current practice, recent advances, and future directions.
  
  
  RESULTS
  Lung cancer guidelines recommend endosonography - above mediastinoscopy - as the initial test for mediastinal nodal tissue staging. By introducing the EBUS-scope into the esophagus (EUS-B) - following an EBUS procedure - the complete mediastinum and the left adrenal gland can be investigated in a single scope procedure by one operator. In patients with suspected stage I/II sarcoidosis, EBUS-TBNA/EUS-FNA is the test with the highest granuloma detection rate. Diagnosing (recurrent) lymphoma is an increasingly accepted indication for endosonography. Systematic surveys showed that endosonography has a low complication rate. Simulator-based training and assessment tools measuring competency are important instruments to provide standardized and optimal implementation.
  
  
  CONCLUSIONS
  Endosonography is generally accepted as a powerful and safe diagnostic test for various diseases affecting the mediastinum. Large-scale implementation is needed.
authors.affiliation: aDepartment of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands *Peter I. Bonta and Laurence Crombag contributed equally to the writing of this article.
authors.forename: Peter I
authors.initials: PI
authors.lastname: Bonta
authors.forename: Laurence
authors.initials: L
authors.lastname: Crombag
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Annema
mesh_terms: D044963:Biopsy, Fine-Needle; D019160:Endosonography; D004947:Esophagus / Q000000981:diagnostic imaging*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008481:Mediastinoscopy