EUS-B FNA of Enlarged Left Adrenal Gland in Lung Cancer-Case Series

Combined endobronchial and endoscopic ultrasound via bronchoscope (EBUS EUS-B) is an established method for diagnosis, staging and tissue acquisition in lung cancer. With incorporation of EUS-B fine needle aspirate (EUS-B FNA) of enlarged left adrenal gland (LAG), combined EBUS EUS-B can aid in excluding metastatic spread or differentiating between regional (M1a) versus distant (M1b) single organ or multi-organ metastatic disease (M1c). In comparing, EUS FNA of LAG via conventional gastro-echoendoscope with EUS-B, conventional EUS can successfully visualise LAG more frequently. However, once visualization is achieved, outcomes in terms of diagnostic yield and tissue adequacy are comparable. Complication and adverse event rates are low. EUS-B FNA of LAG is aligned with patient-centric benefits of combined EBUS EUS-B. In our case series, we illustrate the use of EUS-B FNA for diagnosis, staging and tissue acquisition in lung cancer. We highlight learning points, discuss risk and benefits and advocate for broader integration into clinical practice.