Should Eus-B Be Added To Ebus?

Introduction: Guidelines recommend Endobronchial Ultrasound (EBUS) and/or Endoscopic Ultrasound (EUS) for nodal staging of lung cancer. The added value of EUS-B to EBUS is under discussion and so far only assessed in a single center tertiary referral setting. Aim: To investigate the added value of EUS with the EBUS scope (EUS-B) to EBUS for loco-regional nodal staging including T4 assessment. Methods: Prospective, multicenter study in patients with (suspected) Non-Small Cell Lung Cancer (NSCLC) and an indication for invasive mediastinal nodal staging. EUS-B was performed following a systematic EBUS evaluation including routine aspiration of nodes with short axis greater than 8 mm. Surgery with nodal dissection was the reference standard whenever endosonography was negative. Results: 80 patients (mean age 65 years, 50 male) were evaluated according to protocol. Final diagnosis was NSCLC, SCLC, benign and other in 68, 6, 4 and 2 patients, respectively. The prevalence of advanced disease (N2-3/T4) was 34/80 (43%). In 9 (11%) patients EUS-B had an added value to EBUS based on the detection of nodal metastases (3 N2, 3 N3) metastases or mediastinal tumor invasion (3 T4). Endosonography results were false negative in 6 patients (5 N2, 1 T4). Conclusion and implication: The routine addition of EUS-B to EBUS results in improved loco-regional staging of patients with NSCLC. Therefore, the use of EUS-B added to EBUS should be encouraged.