Laurence M M J Crombag1, Artur Szlubowski2, Jos A Stigt3, Olga Schuurbiers4, Daniël A Korevaar5, Peter I Bonta6, Jouke T Annema7. 1. Dept. of Pulmonology, F5-144, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: l.m.crombag@amc.nl. 2. Endoscopy Unit, Pulmonary Hospital in Zakopane, Poland. 3. Dept. of Pulmonary Diseases, Isala Clinics, Zwolle, The Netherlands. 4. Dept. of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Dept. of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 6. Dept. of Pulmonology, F5-144, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. 7. Dept. of Pulmonology, F5-144, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: j.t.annema@amc.nl.
Abstract
INTRODUCTION: In patients with lung cancer, left adrenal glands (LAG) suspected for distant metastases (M1b) based on imaging require further evaluation for a definitive diagnosis. Tissue acquisition is regularly performed using conventional EUS-FNA. The aim of this study was to investigate the success rate of endoscopic ultrasound guided fine-needle aspiration using the EBUS scope (EUS-B-FNA) for LAG analysis. METHODS: This is a prospective multicenter study in consecutive patients with (suspected) lung cancer and suspected mediastinal and LAG metastases. Following complete mediastinal staging using the EBUS scope (EBUS+EUS-B), the LAG was evaluated and sampled by both EUS-B (experimental procedure) and conventional EUS (current standard of care). RESULTS: The success rate for LAG analysis (visualized, sampled and adequate tissue obtained) was 89% (39/44; 95% CI 76-95%) for EUS-B-FNA, and 93% (41/44; 95%CI 82-98%) for EUS-FNA. In the absence of metastases at EUS-B and/or EUS, surgical verification of the LAG or 6 months clinical and radiological follow-up was obtained, but missing for 5 patients. The prevalence of LAG metastases was 54% (21/39). In patients in whom LAG was seen and sampled, sensitivity for LAG metastases was at least 87% (95%CI 65-97%) for EUS-B, and at least 83% (95%CI 62-95%) for conventional EUS. CONCLUSION: LAG analysis by EUS-B shows a similar high success rate in comparison to conventional EUS. IMPLICATION: Both a mediastinal nodal and LAG evaluation can be adequately performed with just an EBUS scope and single endoscopist. This staging strategy is likely to reduce patient-burden and costs.
INTRODUCTION: In patients with lung cancer, left adrenal glands (LAG) suspected for distant metastases (M1b) based on imaging require further evaluation for a definitive diagnosis. Tissue acquisition is regularly performed using conventional EUS-FNA. The aim of this study was to investigate the success rate of endoscopic ultrasound guided fine-needle aspiration using the EBUS scope (EUS-B-FNA) for LAG analysis. METHODS: This is a prospective multicenter study in consecutive patients with (suspected) lung cancer and suspected mediastinal and LAG metastases. Following complete mediastinal staging using the EBUS scope (EBUS+EUS-B), the LAG was evaluated and sampled by both EUS-B (experimental procedure) and conventional EUS (current standard of care). RESULTS: The success rate for LAG analysis (visualized, sampled and adequate tissue obtained) was 89% (39/44; 95% CI 76-95%) for EUS-B-FNA, and 93% (41/44; 95%CI 82-98%) for EUS-FNA. In the absence of metastases at EUS-B and/or EUS, surgical verification of the LAG or 6 months clinical and radiological follow-up was obtained, but missing for 5 patients. The prevalence of LAG metastases was 54% (21/39). In patients in whom LAG was seen and sampled, sensitivity for LAG metastases was at least 87% (95%CI 65-97%) for EUS-B, and at least 83% (95%CI 62-95%) for conventional EUS. CONCLUSION: LAG analysis by EUS-B shows a similar high success rate in comparison to conventional EUS. IMPLICATION: Both a mediastinal nodal and LAG evaluation can be adequately performed with just an EBUS scope and single endoscopist. This staging strategy is likely to reduce patient-burden and costs.
Authors: Douglas G Adler; Moamen Gabr; Linda Jo Taylor; Benjamin Witt; Douglas Pleskow Journal: Endosc Ultrasound Date: 2018 Nov-Dec Impact factor: 5.628
Authors: Christoph F Dietrich; Paolo Giorgio Arcidiacono; Barbara Braden; Sean Burmeister; Silvia Carrara; Xinwu Cui; Milena Di Leo; Yi Dong; Pietro Fusaroli; Uwe Gottschalk; Andrew J Healey; Michael Hocke; Stephan Hollerbach; Julio Iglesias Garcia; André Ignee; Christian Jürgensen; Michel Kahaleh; Masayuki Kitano; Rastislav Kunda; Alberto Larghi; Kathleen Möller; Bertrand Napoleon; Kofi W Oppong; Maria Chiara Petrone; Adrian Saftoiu; Rajesh Puri; Anand V Sahai; Erwin Santo; Malay Sharma; Assaad Soweid; Siyu Sun; Anthony Yuen Bun Teoh; Peter Vilmann; Hans Seifert; Christian Jenssen Journal: Endosc Ultrasound Date: 2019 Nov-Dec Impact factor: 5.628
Authors: Rana Bibi; Uffe Bodtger; Rafi Nessar; Henrik K Jensen; Ida Skovgaard Christiansen; Paul F Clementsen Journal: Respirol Case Rep Date: 2020-02-05