Accuracy and Predictors of Success of EUS-B-FNA in the Diagnosis of Pulmonary Malignant Lesions: A Prospective Multicenter Italian Study

Abstract

<b><i>Background:</i></b> The role of endoscopic ultrasound with bronchoscope fine-needle aspiration (EUS-B-FNA) in the diagnosis of suspected malignant pulmonary lesions adjacent to the esophagus has been poorly investigated. The aim of the present study was to assess the accuracy of EUS-B-FNA for the diagnosis and molecular profiling of paraesophageal pulmonary lesions, as well as its predictors of success. <b><i>Materials and Methods:</i></b> Patients who underwent EUS-B-FNA for the diagnosis of paraesophageal lesions were consecutively enrolled in four Italian centers. Demographic, clinical, procedural, pathological, and molecular characteristics of the malignant samples were collected. The primary outcome was the diagnostic accuracy for pulmonary malignancies. Secondary outcomes were diagnostic yield and predictors of success for diagnosis and molecular profiling. <b><i>Results:</i></b> 107 adult patients (60 [56.1%] males; median (interquartile range) age: 69 [60–70] years) were enrolled. The diagnostic accuracy of EUS-B-FNA was 95.3% in the overall cohort and 95.2% in the 99 patients with a final diagnosis of malignancy. Neither clinical nor procedural variables significantly affected the diagnostic accuracy, whereas rapid on-site evaluation (ROSE), performed by pathologists or trained pulmonologists, was a strong predictor for a complete molecular profiling (OR [95% CI]: 12.9 [1.2–137.4]; <i>p</i> value: 0.03). <b><i>Conclusion:</i></b> EUS-B-FNA is a safe and accurate method for the diagnosis of paraesophageal pulmonary lesions. The presence of ROSE is relevant for a complete molecular profiling in this selected cohort of patients with advanced lung cancer.

Transesophageal endoscopic ultrasound-guided tissue acquisition of lung masses: a case series with systematic review and meta-analysis

“…Among the included studies, 17 were full-text articles [ 10 - 17 , 20 - 28 ], while 2 were conference abstracts [ 18 , 19 ]. Based on the study design, 6 studies were prospective [ 11 , 13 , 18 , 24 , 26 , 27 ], and the remaining 13 were retrospective [ 10 , 12 , 14 - 17 , 19 - 23 , 25 , 28 ]. The diagnostic test was EUS-FNA/FNB in 15 studies [ 10 - 21 , 24 , 25 , 28 ] and EUS-B-FNA [ 22 , 23 , 26 , 27 ] in 4 studies.…”

“…Based on the study design, 6 studies were prospective [ 11 , 13 , 18 , 24 , 26 , 27 ], and the remaining 13 were retrospective [ 10 , 12 , 14 - 17 , 19 - 23 , 25 , 28 ]. The diagnostic test was EUS-FNA/FNB in 15 studies [ 10 - 21 , 24 , 25 , 28 ] and EUS-B-FNA [ 22 , 23 , 26 , 27 ] in 4 studies. Ten studies used only a 22-G needle [ 10 - 12 , 14 , 16 , 21 , 22 , 24 - 26 ], 7 studies used a variety of needle sizes ranging from 19-25-G [ 15 , 17 , 18 , 20 , 23 , 27 , 28 ], and 2 studies did not report the type of needle used [ 13 , 19 ].…”

“…The diagnostic test was EUS-FNA/FNB in 15 studies [ 10 - 21 , 24 , 25 , 28 ] and EUS-B-FNA [ 22 , 23 , 26 , 27 ] in 4 studies. Ten studies used only a 22-G needle [ 10 - 12 , 14 , 16 , 21 , 22 , 24 - 26 ], 7 studies used a variety of needle sizes ranging from 19-25-G [ 15 , 17 , 18 , 20 , 23 , 27 , 28 ], and 2 studies did not report the type of needle used [ 13 , 19 ]. shows the details of the study quality analysis.…”

“…shows the details of the study quality analysis. Study quality assessment showed that 2 were of high quality [ 11 , 27 ], 10 were of medium quality [ 10 , 13 , 15 , 16 , 20 - 24 , 28 ], and 7 were of low quality [ 12 , 14 , 17 - 19 , 25 , 26 ].…”

Endoscopic ultrasound to the rescue of pancoast tumour

“…A recent multicentric study from Italy reported the efficacy and safety of EUS-guided tissue sampling as a minimally invasive procedure for the diagnosis and staging of peri-oesophageal parenchymal lung lesions. [ 2 ] However, transoesophageal FNA from lung mass may be rarely associated with pneumothorax[ 3 ] and haemoptysis. [ 4 ] Hence, a check X-ray should be done to rule out pneumothorax before discharging the patient.…”