Abstract
Full minimally invasive evaluation of all lymph node stations (with the exception of station 6) is now possible with the advent of endobronchial and trans-esophageal endoscopic ultrasound. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) allows sampling of mediastinal lymph nodes relevant to lung cancer staging, particularly in the subcarinal area (station 7), lower para-esophageal lymph nodes (station 8), inferior pulmonary ligament lymph nodes (station 9), and celiac lymph nodes. EUS-FNA is an extremely powerful nonsurgical option for sampling metastatic nodes, sarcoidosis, and lymphoma. Both adrenal glands can be sampled by EUS-FNA through the trans-gastric approach or the trans-duodenal approach. EUS-FNA is also able to sample central primary lung masses abutting the esophagus, particularly when other techniques fail. EBUS-FNA has the distinct advantage to reach areas that have proven inaccessible to EUS. These stations include the right and left upper and lower para-tracheal areas (4R and 4L; 2R and 2L), right and left hilar areas (station 10) and the right and left interlobar stations (station 11). It is best to work in a multidisciplinary fashion with colleagues in thoracic surgery, pulmonary, radiology, and oncology to individualize the best staging approach for the patient.
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Robbins, D.H., Reddy, B., Eloubeidi, M.A. (2010). Role of EUS in Mediastinal Nodes, Masses, Cysts, and Lung Cancer. In: Shami, V.M., Kahaleh, M. (eds) Endoscopic Ultrasound. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-480-7_8
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DOI: https://doi.org/10.1007/978-1-60327-480-7_8
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