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Copyright ©ERS Journals Ltd 2006
Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions
1 Dept of Pulmonology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany, 2 Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands, 3 Unit of Pulmonary Diseases, Dept of Internal Medicine, Immunoallergic and Respiratory Diseases, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
CORRESPONDENCE: F. J. F. Herth, Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Amalienstraße 5, D-69126 Heidelberg, Germany. Fax: 49 62213961202. E-mail: Felix.Herth{at}thoraxklinik-heidelberg.de
Keywords: Endobronchial ultrasound-guided transbronchial needle aspiration, transoesophageal ultrasound-guided fine needle aspiration, transbronchial needle aspiration
Received: January 30, 2006
Accepted September 25, 2006
A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging as well as the assessment of mediastinal masses. Transbronchial needle aspiration (TBNA) is a safe procedure that is performed during routine bronchoscopy. Provided mediastinal metastases are confirmed, TBNA has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of real-time needle visualisation. The introduction of echo-endoscopes has overcome this problem.
Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures.
It is expected that implementation of minimally invasive endoscopic methods of endobronchial ultrasound-guided transbronchial needle aspiration and transoesophageal ultrasound-guided fine needle aspiration will reduce the need for surgical staging of lung cancer significantly.
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