title: Endobronchial and Endoscopic Ultrasound-Guided Transvascular Biopsy of Mediastinal, Hilar, and Lung Lesions.
abstract: BACKGROUND
  Endoscopic techniques, including endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS), are the initial approach for the diagnosis and staging of lung cancer and the diagnosis of mediastinal and hilar lesions. Historically, the transvascular approach has been avoided because of concerns of bleeding. Here we review our experience with EBUS and EUS transvascular biopsy of mediastinal, hilar, and lung lesions.
  
  
  METHODS
  A prospective research database was used to retrospectively identify and review the records 33 consecutive patients who underwent EBUS and EUS transvascular biopsy in an outpatient setting over 4 years. Complications were identified as significant hematoma seen with endoscopic ultrasound, hemothorax, hemoptysis other than minor, hemodynamic instability, hospital admission, and death.
  
  
  RESULTS
  The biopsies in 14 patients were performed through branches of the pulmonary artery, and 19 were done through the aorta. All EUS biopsies were performed with a 22-gauge needle, and all EBUS biopsies were performed with a 21-gauge needle. Malignancy was diagnosed with specimens from a transvascular biopsy in 16 patients (48.5%). Samples from 8 biopsies (24%) were described as negative for malignancy, and 9 specimens (27%) were described as insufficient. No complications were seen in the immediate postprocedural period, and all 33 patients were discharged home the same day. The median follow-up after the procedure was 12 months, with no complications described. The overall yield was 73%.
  
  
  CONCLUSIONS
  In this series, EBUS- and EUS-guided transvascular approach for biopsy of mediastinal, hilar, and lung lesions was not associated with significant complications. However, careful selection of potential candidates and close periprocedural observation are mandatory.
authors.affiliation: Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada. Electronic address: jordan.kazakov@uhhospitals.org.
authors.forename: Jordan
authors.initials: J
authors.lastname: Kazakov
authors.affiliation: Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
authors.forename: Pravachan
authors.initials: P
authors.lastname: Hegde
authors.affiliation: Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tahiri
authors.affiliation: Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.affiliation: Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001999:Bronchoscopy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D018579:Patient Selection; D011651:Pulmonary Artery; D012189:Retrospective Studies