Endoscopic transesophageal and endoscopic transbronchial real-time ultrasound-guided biopsy

The goal of preoperative staging of non-small-cell lung cancer is to identify patients who will benefit from surgical resection. Various imaging and less invasive modalities are now available to improve therapy decision-making, and with the introduction of multimodality treatment of lung cancer, proper staging of this disease is becoming more and more important. This staging process is therefore not only a question of determining the prognosis, but it is also necessary information for institution of the right treatment. Proper staging and restaging of lung cancer should also be a must in the evaluation of the different treatments of lung cancer in controlled clinical trials. In lung cancer, endoscopic ultrasound scanning (EUS) is emerging as an accurate, nonsurgical alternative to staging the mediastinum through EUS-fine-needle aspiration (EUS-FNA). The author presents publications on evaluating EUS in diagnosing lymph node involvement in lung cancer and tumor ingrowths in the mediastinum. With EUS it is possible to guide FNA with direct visualization of the needle path into the lymph nodes in real time. Although this method is only able to visualize the posterior path and the inferior parts of the mediastinum, it makes it possible to visualize the aortopulmonary window. The limitation of EUS is a sensitivity of about 90%; nonetheless, this method is more precise than other staging procedures except for mediastinoscopy, which is limited to only the anterior parts of the mediastinum.