Endoscopic ultrasound-guided fine-needle aspiration in the mediastinum
- Julia Kim LeBlanc, MD, MPH
Julia Kim LeBlanc, MD, MPH
- Clinical Associate Professor of Medicine
- Indiana University School of Medicine
Endoscopic ultrasound (EUS) is a combination of endoscopy and ultrasonography. It is an effective and safe method of examining the posterior mediastinum, although it was initially developed as a method of evaluating the pancreas [1-3].
EUS should be distinguished from endobronchial ultrasound (EBUS). Both visualize and guide sampling of mediastinal lymph nodes, but EUS is performed during endoscopy and EBUS is performed during bronchoscopy. (See "Endobronchial ultrasound: Technical aspects" and "Endobronchial ultrasound: Indications, contraindications, and complications".)
The procedure and its indications are discussed in this topic review. In addition, the advantages, disadvantages, and complications of EUS are reviewed. Overviews of the evaluation of mediastinal masses and the staging of non-small cell lung cancer (NSCLC) are presented separately. (See "Approach to the adult patient with a mediastinal mass" and "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Tumor node metastasis (TNM) staging system for non-small cell lung cancer".)
Endoscopic ultrasound (EUS) is performed with an echoendoscope (an endoscope with an ultrasound transducer engineered into its tip). The echoendoscope is flexible, approximately 13 mm in diameter, and can obtain reliable images at a depth ranging from 3 mm to 8 cm from the transducer. Two types of echoendoscopes exist, radial and curvilinear. The radial echoendoscope provides a 360-degree ultrasound image of the gastrointestinal tract and surrounding structures (image 1). In contrast, the curvilinear echoendoscope provides a 180-degree view that is parallel to the shaft of the echoendoscope, thereby allowing real-time visualization of fine needle aspiration. Color flow and Doppler features of the curvilinear echoendoscope permit identification of vascular, ductular, and cystic structures.
The procedure begins once the patient is adequately sedated. The radial echoendoscope is passed through the mouth until the tip reaches the duodenum, and then withdrawn slowly in 1 to 2 cm increments while ultrasound imaging is performed:
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- Fine needle aspiration
- EUS-guided core biopsy
- Benign diseases
- Malignant diseases
- - Lung cancer
- - Other malignancies
- STAGING NSCLC
- Primary tumor (T)
- Lymph nodes (N)
- - No lymphadenopathy
- - Molecular analysis
- Metastasis (M)
- SUMMARY AND RECOMMENDATIONS