E(B)US-guided pulmonary interventions

Transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) enables minimally invasive tissue sampling of mediastinal lymph nodes. There is convincing evidence that EUS-FNA is an accurate method for mediastinal staging of patients with non small cell lung cancer (NSCLC), and therefore EUS-FNA provides an alternative for surgical evaluation of the mediastinum. Due to the complementary reach in analyzing different mediastinal regions, additional staging by EUS-FNA to mediastinoscopy improves preoperative staging of NSCLC and therefore reduces the number of futile thoracotomies. Preliminary data suggest an important role for EUS-FNA in the assessment of mediastinal tumor invasion as well as mediastinal restaging after prior chemo (radiation) therapy. For interstitial lung diseases, EUS-FNA has been demonstrated to be an accurate method in diagnosing sarcoidosis. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a novel diagnostic method by which mediastinal, hilar, and intrapulmonary nodes can be aspirated under real-time ultrasound control from the trachea or main bronchi. EBUS-TBNA can be performed in an ambulatory setting and has been proven to be accurate in mediastinal staging of patients with NSCLC. Like EUS-FNA, EBUS-TBNA is an alternative for mediastinoscopy. EUS-FNA and EBUS-TBNA have a complementary reach for various mediastinal nodal stations, and recent studies indicate that complete and accurate locoregional staging of NSCLC can be achieved by the combination of EUS-FNA and EBUS-TBNA.