Endoscopic ultrasound-guided fine-needle aspiration in the staging and diagnosis of patients with lung cancer

With the advent of endobronchial and esophageal endoscopic ultrasound (EUS), current data suggest that most mediastinal stations can be reached with minimally invasive staging with the exception of stations 5 and 6. EUS fine-needle aspiration (FNA) is a minimally invasive technique that allows sampling of mediastinal lymph nodes relevant to lung cancer staging, particularly in the subcarinal area (station 7), lower paraesophageal lymph nodes (station 8), inferior pulmonary ligament lymph nodes (station 9), and celiac lymph nodes. In addition, EUS-FNA is capable of sampling metastatic, sarcoidosis, and lymphoma harboring lymph nodes. The left adrenal gland is easily sampled by EUS-FNA through the transgastric approach. EUS-FNA is also able to sample central primary lung masses abutting the esophagus, particularly when other techniques fail. By working in a multidisciplinary fashion with colleagues in thoracic surgery, pulmonary, and oncology, the best initial staging approach for each patient can be individualized.