Endoscopic ultrasound in interventional pulmonology

Elliot Ho, Pravachan Hegde

Abstract

Lung cancer is the leading cause of cancer related deaths worldwide. Accurate staging of the mediastinum is essential to determine the appropriate treatment plan in patients with potentially operable non-small cell lung cancers (NSCLC). Traditionally, the gold standard test in mediastinal staging has been cervical mediastinoscopy. However, this procedure is invasive, requires general anesthesia, and is associated with significant risk. Training in endoscopic ultrasound (EUS) techniques in addition to endobronchial ultrasound (EBUS) allows for diagnosis and complete staging of lung cancer in a single session, thereby decreasing healthcare cost, time delays, increased sedation time, and patient discomfort. With its superior cost-effectiveness and reduced risk profile compared to conventional mediastinoscopy, endoscopic approach has replaced mediastinoscopy as the initial step in lung cancer staging and diagnosis. Here we discuss the utility of EUS along with combined EBUS with EUS, and highlight some of the technical aspects of the procedure. We will review the current role of EUS technique for the evaluation of mediastinal adenopathy and staging of lung cancer. We will also briefly discuss its use in diagnosing mediastinal infection and granulomatous lesions in the thoracic cavity.