Endoscopic ultrasound (b)-guided sampling of lung nodules, lymphadenopathy, and adrenal lesions: a single-center experience

SESSION TITLE: Procedures Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Procedures utilized in the diagnosis and staging of lung cancer (bronchoscopic or computed tomography-guided needle aspiration) are not without both anatomical and technical limitations. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now considered the standard of care for mediastinal staging. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can be particularly useful in the diagnosis of para-esophageal lesions. EBUS-TBNA and EUS-FNA are often recognized as complementary procedures that could occur during a single patient encounter; however, only a few such reports are available in the literature. We present a case series describing a center single-center experience with interventional pulmonologists performing EUS-FNA during diagnostic bronchoscopy. METHODS: We retrospectively analyzed the results of diagnostic bronchoscopy in which EUS-FNA was utilized given that location of lung or mediastinal lesions made it inaccessible by standard bronchoscopy, guided bronchoscopy, or EBUS-TBNA. Cases were performed over 2 years from November 2020 to October 2022. Olympus EBUS bronchoscope was used for the EUS portion (EUS-B) of all procedures with oxygen insufflation and fluoroscopic guidance. Where indicated, EBUS-TBNA preceded EUS-B. An endoscopic examination was conducted post-sampling to ensure no significant bleeding was noted from the esophagus or stomach. All patients received prophylactic antimicrobial therapy. Data regarding the indication, location, size, timing, yield, and complications were collected. RESULTS: A total of 11 procedures included EUS-B guided sampling of lesions in addition to staging EBUS-TBNA. Of the cases, 8 were nodules (4 right lower lobe, 1 right upper lobe, and 2 left upper lobe), 1 left upper lobe mass, 1 paraaortic lymph node, and 1 metastatic lesion of the left adrenal gland. The mean total procedure duration was 83 minutes. The diagnostic yield was 9/11 (81% of cases), all of which were malignant. Of the 2 nodules without definitive diagnoses, one was later diagnosed on video-assisted thoracoscopic surgery (VATS) as granulomatous inflammation. The other had atypical cells, later confirmed as non-small cell lung cancer with a rheumatoid nodule on VATS. There were no instances of bleeding or pneumothorax post-procedure. CONCLUSIONS: In experienced hands and carefully selected patients, EUS-guided lesion sampling is feasible, with high yield and without significant complications. CLINICAL IMPLICATIONS: EUS-B complimentary to EBUS-TBNA performed by experienced bronchoscopists can increase the yield of diagnosis, particularly in anatomically challenging lesions. The ability to perform both procedures during a single encounter could prove beneficial to patient care in decreasing the burden of additional procedures and general anesthesia requirements. Larger, prospective trials are warranted to explore its diagnostic potential and yield. DISCLOSURES: Consultant relationship with VisionAir Solutions Please note: 02/2022 - 03/2022 Added 12/01/2022 by Sameer Avasarala, source=Web Response, value=Consulting fee No relevant relationships by Damarys Hernandez No relevant relationships by Tanmay Panchabhai No relevant relationships by Olivia Rizzo No relevant relationships by Benjamin Young