LAUSR

Background: Diagnosing centrally located lung tumors without endobronchial abnormalities is a diagnostic challenge. Tumors located adjacent to the esophagus can be aspirated and detected with EUS using GI endoscopes. The feasibility and yield of EUS-B (use of the EBUS scope in the esophagus) is unknown. Objective: To assess the feasibility and diagnostic yield of EUS-B-FNA in centrally located lung tumors and its added value to bronchoscopy and EBUS. Methods: Retrospective multicentre international analysis (from 01-2015 until 12-2017) of patients with suspected lung cancer, undergoing a bronchoscopy, EBUS and EUS-B in one session by a single operator (pulmonologist), in which the primary lung tumor was detected and aspirated by EUS-B. In the absence of malignancy following endoscopy, clinical and radiological follow-up of 6 months was performed. The yield and sensitivity of EUS-B-FNA and its added value to bronchoscopy and EBUS was assessed. Results: 58 patients were identified with the following diagnosis: NSCLC (n=43), SCLC (n=6), Mesothelioma (n=2), metastasis (n=1), non-malignant (n=6). The diagnostic yield and sensitivity of EUS-B-FNA for detecting lung cancer was 90%. In 26 patients (45%), the intrapulmonary tumor was exclusively detected by EUS-B. Adding EUS-B to conventional bronchoscopy and EBUS increased the diagnostic yield for diagnosing lung cancer in centrally located lung tumors from 51% to 90%. No EUS-B related complications were observed. Conclusion: EUS-B-FNA is a feasible and safe technique for diagnosing centrally located intrapulmonary tumors that are located near or adjacent to the esophagus. EUS-B should be considered in the same endoscopy session following a non-diagnostic bronchoscopy and EBUS