title: Pulmonologist-performed transoesophageal sampling for lung cancer staging using an endobronchial ultrasound video-bronchoscope: an Australian experience.
abstract: BACKGROUND
  Transoesophageal endobronchial ultrasound (EBUS) video-bronchoscope insertion provides pulmonologists access to conduct endoscopic fine-needle aspiration (EUS-B-FNA) of mediastinal lymph node (LN) lesions and also assist in lung cancer staging by sampling left adrenal gland (LAG) lesions. Limited literature has described additional diagnostic value whilst maintaining patient safety. To elicit whether combining endoscopic transoesophageal fine-needle aspiration using convex probe bronchoscope (EUS-B-FNA) and EBUS bronchoscopy enhances the diagnostic yield of mediastinal nodal staging in lung cancer, whilst maintaining safety.
  
  
  METHODS
  All eligible patients with paraoesophageal lesions on thoracic computed tomography (CT) underwent pulmonologist-performed EUS-B-FNA at two tertiary centres and were included in this prospective observational cohort study.
  
  
  RESULTS
  EUS-B-FNA sampling was performed at 69 mediastinal LN lesion sites, including 17 sites inaccessible to bronchoscopic sampling. Four LAG lesions were sampled via EUS-B-FNA. There were no complications. EBUS-TBNA was augmented by EUS-B-FNA because of accessibility of sampling lesions otherwise unamenable bronchoscopically, thereby increasing diagnostic utility. Diagnostic sensitivity of EUS-B-FNA for malignancy in mediastinal LN lesions was 88% (51 of 58). For mediastinal LN lesions not amenable to EBUS-TBNA, the sensitivity for diagnosis of malignancy via EUS-B-FNA was 88% (15 of 17). Diagnostic sensitivity of EUS-B-FNA for malignancy in LAG lesions was 50% (2 of 4).
  
  
  CONCLUSIONS
  EUS-B-FNA is a precise and safe approach in the evaluation and staging of lung cancer when performed by a pulmonologist. It complements and increases the diagnostic utility of EBUS-TBNA by further coverage of mediastinal LN stations and access to LAG lesions.
authors.affiliation: Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Hari
authors.initials: H
authors.lastname: Wimaleswaran
authors.affiliation: Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Farmer
authors.affiliation: Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Louis B
authors.initials: LB
authors.lastname: Irving
authors.affiliation: Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Barton R
authors.initials: BR
authors.lastname: Jennings
authors.affiliation: Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Steinfort
mesh_terms: D001315:Australia; D001999:Bronchoscopy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D000072106:Pulmonologists; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: bronchoscopy; diagnosis and staging endoscopy; diagnostic procedures; endoscopic ultrasound; fine needle aspirate; lung cancer