title: Pulmonologist-Performed Per-Esophageal Needle Aspiration of Parenchymal Lung Lesions Using an EBUS Bronchoscope: Diagnostic Utility and Safety.
abstract: BACKGROUND
  Transesophageal introduction of the endobronchial ultrasound (EBUS) videobronchoscope allows pulmonologists to perform endoscopic ultrasound fine-needle aspiration (EUS-B-FNA) of mediastinal lesions. Safety, diagnostic accuracy, and feasibility of EUS-B-FNA in evaluation of pulmonary parenchymal lesions are not established.
  
  
  METHODS
  All patients undergoing pulmonologist-performed EUS-B-FNA of parenchymal lung lesions at 2 tertiary centers were included in this prospective observational cohort study.
  
  
  RESULTS
  EUS-B-FNA sampling of parenchymal lesions was performed in 27 patients. Mean (±SD) lesion size was 36±16 mm. Seven lesions were ≤18 mm. Pneumothorax occurred in 1 patient (3.7%, 95% confidence interval, 0.001%-19%). Ten target lesions (36%) were in locations inaccessible to bronchoscopic sampling via the airways, and 9 lesions were inaccessible to EBUS-guided transbronchial needle aspiration and in locations associated with low diagnostic yield from radial EBUS. EUS-B-FNA was diagnostic in 26 patients (96%), and sensitivity of EUS-B-FNA was 100% (95% confidence interval, 87%-100%) for both lung cancer (n=21) and for pulmonary metastatic lesions (n=5).
  
  
  CONCLUSIONS
  Pulmonologist-performed EUS-B-FNA is safe and accurate in the evaluation parenchymal lung lesions. Diagnostic accuracy is high. EUS-B-FNA may achieve access to sites not amenable to other forms of bronchoscopic sampling, or increase diagnostic accuracy in patients where anatomic position predicts a low diagnostic yield.
authors.affiliation: *Department of Respiratory Medicine, Royal Melbourne Hospital†Department of Medicine, University of Melbourne, Parkville‡Department of Respiratory and Sleep Medicine, Monash Medical Centre, Clayton, Vic., Australia.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Steinfort
authors.forename: Michael W
authors.initials: MW
authors.lastname: Farmer
authors.forename: Louis B
authors.initials: LB
authors.lastname: Irving
authors.forename: Barton R
authors.initials: BR
authors.lastname: Jennings
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D020680:Bronchoscopes; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects / Q000379:methods*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D000072106:Pulmonologists; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed