Characterization of Lung Tumors that the Pulmonologist can Biopsy from the Esophagus with Endosonography (EUS-B-FNA)

Abstract

<b><i>Background:</i></b> According to guidelines, it is possible to biopsy lung tumors “immediately adjacent to the esophagus” with EUS-B-FNA. However, it is unknown what “immediately adjacent” exactly means. <b><i>Objective:</i></b> to investigate the possibility of achieving EUS-B-FNA biopsies from a lung tumor depending on the distance from the esophagus and to establish the maximal allowable distance between the tumor and the esophagus. <b><i>Methods:</i></b> In a prospective observational study, we included patients with a lung tumor located maximum 6 cm from the esophagus and indication of EUS-B-FNA from the tumor. The tumors were of different sizes. In a plot presenting the tumor size-distance relationship in cases with (biopsy) versus without (non-biopsy) successful EUS-B-FNA, a separation line representing the threshold between the groups were identified and a biopsy-index equation established. The maximal tumor-size corrected distance (TSCD) was calculated using the residuals to the separation line. <b><i>Results:</i></b> In total, 70 patients were included. EUS-B-FNA from the lung tumor was possible in 46 patients. All tumors with a distance from the esophagus below 19 mm could be biopsied. The maximal allowable esophagus-tumor distance depended on tumor size. From the separation line, a biopsy-index equation was established with the sensitivity of 93.5%, a specificity of 100%, and total accuracy of 95.7%. The TSCD was 31 mm (sensitivity: 95.7%, specificity 75.0%, and accuracy: 88.6%). <b><i>Conclusion:</i></b> We established a biopsy-index equation to predict the achievability of a lung tumor using EUS-B-FNA depending on distance to esophagus and tumor size. A general maximal TSCD was 31 mm.

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.…”

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

“…A recent prospective study found a diagnostic yield of 85% for pulmonary lesions [9]. The rate of complications they reported was negligible [9-11].…”

“…Skovgaard Christiansen et al found that the possibility to biopsy of an intrapulmonary lesion by EUS-B-FNA depends on the distance from the esophagus and the size of the lesion [11]. Tournoy et al and Almeida et al failed to demonstrate a relationship between the accuracy of EBUS-TBNA and the size and the anatomical location of the parenchymal lesion [12][13][14][15][16][17][18][19].…”

“…Needle aspirations were deemed adequate when the material was sufficient for a cytopathological diagnosis [9][10][11]. In case of advanced/metastatic non-small cell lung cancer diagnosis, samples were adequate for molecular assessment if the material was sufficient for a complete molecular testing (EGFR, KRAS, and BRAF mutations; ALK and ROS1 rearrangements; and PD-L1 testing).…”

“…Collection of an adequate quantity of pulmonary material for cytological and molecular diagnosis (e.g., genotyping and programmed death ligand 1 [PD-L1] testing) is key to choose the most appropriate therapy [2,7,8] in patients with advanced/metastatic non-small cell lung cancer. Few retrospective studies showed a good diagnostic yield of EUS-B-FNA in the diagnosis of parenchymal lesions located near to the esophagus [9][10][11].…”