TRANS AORTIC EUS GUIDED FNA IN THE DIAGNOSIS OF LUNG CANCERS AND MEDIASTINAL LYMPH NODES

Background:

Obtaining a tissue diagnosis from a lung tumour or a mediastinal lymph node located lateral to the aorta (para-aortal) is a diagnostic challenge because of the interposition of the aorta. Invasive surgical procedures like mediastinotomy, thoracotomy, or video-assisted thoracic surgery is required for the diagnosis of these lesions. Lymph nodes on the “far-side” of major blood vessels can be visualized by EUS, however FNA is avoided due to concern for bleeding complications

Objective:

To evaluate the feasibility, yield, and safety of EUS-guided transaortic FNA of lung tumours and para-aortic lymph nodes.

Methods:

A retrospective case series of 12 consecutive patients with suspected lung cancer or tuberculosis who underwent transaortic FNAC during a study period of 7 years. Based on CT/PET imaging, a transesophageal FNAC performed through the aorta was considered as the only option to diagnose or stage these patients by means of a minimally invasive procedure. Seven patients had left-sided lung mass. Four patients has enlarged para-aortic lymph node, suspicious for IASLC stations 5 (n = 1) and 6 (n = 3). EUS was performed with a linear echoendoscope. All aspirates were obtained under real-time US guided FNA by using a 22/25-gauge needle. A single real-time FNA of the lung mass or lymph node was performed.

Results:

The final diagnosis was known in 11 patients (5 non-small-cell lung carcinoma [NSCLC], 2 small-cell lung carcinoma [SCLC], 3 tuberculosis and one thymolipoma). EUS-FNA established diagnosis in 9 of 12 patients (75%). One procedure was abandoned due to complication.

Conclusion:

This case series demonstrates the feasibility and probable safety of single EUS guided transaortic aspiration in para-aortic lesions. The diagnostic yield is 75 percent. Clearly, further study and very careful selection by expert EUS operators is needed before this procedure can be routinely recommended.