Convex probe endobronchial ultrasound guided transbronchial/transoesophageal fine needle aspiration (C-EBUS-TBNA/EUS-B FNA) of pleural lesions: A single center experience and review of literature

Abstract

<jats:p>The evaluation of pleural diseases has been well established. If pleurocentensis is non-diagnostic, the second investigation depending upon availability could be either closed pleural biopsy or image guided pleural biopsy or thoracoscopic pleural biopsy (medical or surgical). Pleural disease presenting as thickness/mass/nodule in the mediastinum is difficult to access through ultrasound or computed tomography and will need thoracoscopy. Thoracoscopy is an invasive procedure which can be difficult to perform in localized mediastinal pleural disease without effusion or poor health condition not suitable for general anesthesia. An alternative method that can be utilized is sampling of pleural lesion through convex probe endobronchial ultrasound (CEBUS) either through the central large airways or from esophagus if the lesions are in proximity. We present our center’s experience in diagnosing pleural lesion using C-EBUS in 4 patients along with review of the literature.</jats:p>

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities

“…Similarly, EBUS-TBNA and EUS-B-FNA could be both used to diagnose metastatic involvement of the pleura, as reported in various case series [85,88,89] by renal cell carcinoma, adenoid cystic adenocarcinoma and Hodgkin's B cell lymphoma.…”

“…The approach to pleural lesions suspected for mesothelioma could also be performed by the esophagus with the EUS-B-FNA technique, as it was reported in four case reports [87][88][89][90], where the pleural thickness was in close proximity to the esophagus with a high diagnostic yield.…”

Pleural mesothelioma: When echo‐endoscopy (EUS‐B‐FNA) leads to diagnosis in a minimally invasive way

“…In several of these patients, echo‐endoscopy was not the only procedure that was undertaken. While EBUS‐TBNA was performed in nine of these cases, 11–16 in the other four patients EUS‐B FNA was performed: two patients had mesothelioma, one had lymphoma and one had metastatic renal carcinoma 16,17 . It has previously been reported that a 22‐gauge needle was used in eight patients 11,13,14,16 and 21‐gauge in one patient 17 …”