Technical description of endoscopic ultrasonography with fine-needle aspiration for the staging of lung cancer

Summary Background : Endoscopic ultrasonography (EUS) is a novel method for staging of the mediastinum in lung cancer patients. The recent development of linear scanners enables safe and accurate fine-needle aspiration (FNA) of mediastinal and upper abdominal structures under real-time ultrasound guidance. However, various methods and equipment for mediastinal EUS–FNA are being used throughout the world, and a detailed description of the procedures is lacking. A thorough description of linear EUS–FNA is needed. Methods : A step-by-step description of the linear EUS–FNA procedure as performed in our hospital will be provided. Ultrasonographic landmarks will be shown on images. The procedure will be related to published literature, with a systematic literature search. Results : EUS–FNA is an outpatient procedure under conscious sedation. The typical linear EUS–FNA procedure starts with examination of the retroperitoneal area. After this, systematic scanning of the mediastinum is performed at intervals of 1–2cm. Abnormalities are noted, and FNA of the abnormalities can be performed. Specimens are assessed for cellularity on-site. The entire procedure takes 45–60min. Conclusions : EUS–FNA is minimally invasive, accurate, and fast. Anatomical areas can be reached that are inaccessible for cervical mediastinoscopy. EUS–FNA is useful for the staging of lung cancer or the assessment and diagnosis of abnormalities in the posterior mediastinum.