EUS-FNA and EBUS-TBNA in pulmonary medicine: consensus report of the Belgian Working Party for Thoracic Endoscopy

V O L . 2 I S S U E 6 2 0 0 8 316 Introduction Pathological examination of pulmonary tissue is important for a plethora of lung diseases. Tissue is necessary to obtain a pathological diagnosis, or in case of lung cancer, to obtain clinical staging information (lymph node invasion and metastasis). Sputum examination, bronchoscopy with tissue sampling, ultrasound or CT-guided trans-thoracic needle aspirations (TTNA) and surgical biopsies represent the classical armentarium for the chest physician. New technical developments in echo-endoscopy have become available that improve the possibilities to obtain pulmonary and mediastinal tissue in a nonsurgical way. Firstly, radial ultrasound miniprobes can be introduced through the biopsy channel of a bronchoscope to perform endobronchial ultrasonography. ese miniprobes are available in some expert centers for several years and can guide the sampling of more peripheral pulmonary lesions and help for the evaluation of invasiveness of radio-occult central lesions. Secondly, and more recently the curved-linear transoesophageal endoscopic ultrasound with real time controlled fine-needle aspirations (EUS-FNA) and curved-linear endobronchial ultrasound with real time controlled transbronchial needle aspirations (EBUS-TBNA) have been introduced (Figure 1 on page 317). According to the need for anaesthesia and the interventional risk, the available methods can be classified as non-invasive, minimally invasive or invasive (Table 1 on page 317). Minimally invasive techniques such as EUS-FNA and EBUS-TBNA are developed to be performed without general anaesthesia, but require local (throat) anaesthesia with or without mild sedation. Summary Obtaining a pathological diagnosis of intrathoracic lesions and obtaining accurate mediastinal staging information from patients with non-small cell lung cancer (NSCLC) remain true challenges in pulmonary medicine. Recently, two new techniques have been introduced that challenge current practice, namely the curvedlinear transoesophageal endoscopic ultrasound with real time guided fine-needle aspirations (EUS-FNA) and curved-linear endobronchial ultrasound with real time guided transbronchial needle aspirations (EBUS-TBNA). These techniques are designed to be performed without general anaesthesia and thus as out-patient procedures. Taking into account the available evidence, the consensus report of the Working Party for Thoracic Endoscopy of the Belgian Thoracic Society on the role of EUS-FNA and EBUS-TBNA in pulmonary medicine anno 2009 is reported.