Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial

Abstract

Background: In lung cancer patients, the adrenal glands are predilection sites for distant metastases. Esophageal endoscopic ultrasound - fine-needle aspiration (EUS-FNA) is a minimally invasive and accurate method for left adrenal gland (LAG) analysis but requires a conventional gastrointestinal echoendoscope. Complete endobronchial and esophageal mediastinal nodal staging can be achieved by just a single endobronchial ultrasound (EBUS) scope, introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. Objectives: The aim of the study was to investigate the feasibility of identifying the LAG with the EBUS scope. Methods: We conducted a retrospective analysis of lung cancer patients who underwent EBUS and EUS-B for mediastinal staging and LAG assessment between January 2013 and May 2015. Results: A total of 143 patients with (suspected) lung cancer were investigated by the combination of EBUS and EUS-B. In 68 of the 80 patients (85%) in whom an attempt was made to identify the LAG, it was feasible to transgastrically detect the LAG with the EBUS scope. In 9 patients with endosonographic signs of malignant involvement, diagnostic transgastric FNAs were obtained in all. In the 12 patients (15%) in whom the LAG was not detected, the contact between the ultrasound transducer and the gastric wall was suboptimal - the length of the scope was not a limiting factor. Conclusions: The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. Implication: In patients with (suspected) lung cancer, in addition to complete hilar and mediastinal staging, LAG assessment using just a single EBUS scope also seems feasible. Prospective studies are indicated.

Rab11a promotes proliferation and invasion through regulation of YAP in non-small cell lung cancer

“…Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases. Despite recent advances in diagnosis and treatment including surgery, chemotherapy, radiotherapy and targeted therapy, the prognosis of NSCLC patient remains poor [4–10]. It is necessary to identify new molecular markers involved in the regulation of lung cancer cell aggressiveness.…”

Endobronchial and endoscopic ultrasound: it only takes an echobronchoscope to tango

“…EBUS has remained an indispensable tool for the evaluation of crucial mediastinal stations in lung cancer staging, especially low paratracheal (4R and 4L), subcarinal (7), hilar (10R and 10 L), and interlobar (11R and 11L). A combination of EUS‐B and EBUS improves in‐depth staging of lung cancer with better patient tolerance and access to evaluate upper paratracheal stations (2R and 2L), the left lower paratracheal station (4L) and possibly the left adrenal gland by a single operator during one session . A recent study demonstrated that combined endosonography showed an increased sensitivity of 9% for N2/N3 disease in lung cancer staging compared to conventional PET‐CT‐targeted EBUS .…”

Endoscopic Ultrasound-Guided Liver Biopsy in the Hands of a Chest Physician

“…Surgery or radiotherapy with curative intent is advised in the case of localized disease. Imaging by CT and/or positron emission tomography should be obtained to characterize the primary lung lesion, the mediastinum, and to search for metastases, but additional tissue staging is frequently required to confirm or exclude metastatic involvement, for example if a lesion in the liver is suspected of malignancy [1,2,3,4,5,6]. …”

“…In recent years, chest physicians have started using an endoscope designed for endobronchial ultrasound (EBUS) in the esophagus (EUS-B) for detection and biopsy of lesions both above and below the diaphragm including the left adrenal gland [3,4,5]. However, EUS-B-FNA from a liver metastasis has never been described before.…”