Integration of the left adrenal into EUS-B - a prospective study.

Transesophageal ultrasound with the EBUS-bronchoscope (EUS-B) facilitates together with EBUS the staging of lung cancer. Whether EUS-B is feasible for the left adrenal gland (LAG) has not been prospectively evaluated. We run a prospective study with all patients that received EBUS from march-august 2017: Group A with a suspected or history of malignancy; group B without suspicion of malignancy and thoracic lymph nodes. In group A EUS-B-fine needle aspiration (FNA) was performed, if (PET)-CT or EUS-B were suspicious. 4 bronchoscopists (>500 EBUS-procedures) participated. LAG was proven malignant in the following conditions (reference standard): histology by FNA or surgery, size alteration after antitumour therapy. 317 patients were included (group A NSCLC n=179, SCLC n=25, extrathoracic tumor n=13; group B n=96). Identification of the LAG was possible in 274 (87.5%). FNA was performed in 78 patients. Diagnostic yield of 88.5%: metastasis in 9 (11.6%), regular adrenal tissue in 59 (75.6%), myelipoma in 1 (1.3%), non-representative in 9 (11.5%) patients. The reference standard proved 12 malignant LAG. This results in PPV, NPV, sensitivity and specificity of 100%, 99%, 75% and 100% respectively. The blinded radiological assessment resulted in lower PPV, NPV, sensitivity and specificity. After a learning curve of 60 procedures each interventionalist was capable to detect the LAG with a 93% probability. No FNA-related adverse events happened. EUS-B is feasible to locate and characterize the LAG. Even with a longer EBUS experience a learning curve needs to be considered. EUS-B-FNA is safe and can be performed with high sensitivity and specificity. When compared to CT and PET-CT, EUS-B has a higher sensitivity and specificity.