Esophageal ultrasound with bronchoscope fine needle aspiration (eus-bfna) in the staging and diagnosis of thoracic malignancies: a case series

SESSION TITLE: Procedures Posters 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Periesophageal and adrenal metastasis are common in patients with thoracic malignancies. Accurate tissue sampling of these areas when diagnosing and staging patients can alter disease stage and treatment recommendations. Liner endobronchial ultrasound (EBUS) bronchoscopes are commonly used within the airways to perform fine needle aspirations of centrally located pulmonary nodules and lymph nodes (LNs). There is growing literature that the use of the EBUS bronchoscope is safe and effective in the upper gastrointestinal track to sample the left adrenal gland, peri-esophageal LNs and centrally located radiographic abnormalities otherwise inaccessible via bronchoscopy. This is achieved by inserting the EBUS scope into the esophagus of the patient (EUS-B) to find and sample lesions. The number of cases in the literature that document the safety and efficacy of this practice is limited. We present this case series of patients who had radiographic abnormalities which required EUS-B to establish the correct diagnosis and stage to guide treatment. METHODS: From 5/16/22 through 3/16/23, 9 patients were identified as having underwent EUS-B in addition to their standard bronchoscopy. The patients were identified through our Quality and Safety Monitoring in Diagnostic Bronchoscopy database (IRB # 21120901). After identification the charts were reviewed in a retrospective fashion. We tracked the location of biopsies, histological findings, stage changes, and complication rates. RESULTS: 9 patients underwent EUS-B during the study period: 8 had FNA sampling performed, 3 patients had LNs nodes samples that were non-accessible via bronchoscopy, 4 had adrenal nodules sampled, 1 pleural nodule was sampled, and 1 left lower lobe nodule was sampled. In 1 case an adrenal nodule was not able to be sufficient visualized and no samples were obtained. Of the 8 sampled sites: 6 of the sites were positive for malignancy and 2 were benign. Of the 6 positive samples: 3 were found to have non-small cell lung cancer, 2 had small cell lung cancer, and 1 had metastatic colorectal cancer. 5 of the patient’s stage of disease increased as a result of the biopsies performed via EUS-B. 2 patients had confirmation of localized disease. No complications occurred. CONCLUSIONS: EUS-B can be a safe and valuable addition to diagnostic bronchoscopy. By combining these procedures, patients can rapidly be diagnosed and staged without the need for multiple procedures. CLINICAL IMPLICATIONS: EUS-B is an important diagnostic tool for patients with thoracic malignancies. When used properly it can reduce the need for multiple procedures and anesthetics; thereby potentially reduce complications and shorten time to treatment. More study is needed to determine what level of training is needed for a proceduralist to be sufficiently competent with EUS-B. Until further study is completed, the procedure should only be utilized by expert endoscopists with the collaboration of multiple specialists. DISCLOSURES: No disclosure on file for Gillian Alex No relevant relationships by Stephen Dingley No relevant relationships by Nicole Geissen No relevant relationships by Justin Karush Consultant relationship with ion / intuitive Please note: 2020-2021 Added 03/29/2023 by James Katsis, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with medtronic Please note: 2021 to present Added 03/29/2023 by James Katsis, source=Web Response, value=Honoraria No relevant relationships by Robert Lentz No relevant relationships by Michael Liptay PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Removed 11/22/2022 by Fabien Maldonado, source=Web Response Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Removed 11/22/2022 by Fabien Maldonado, source=Web Response No disclosure on file for Michael O'Connor Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Noah Medical Please note: 2021 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Intuitive Please note: 1/21 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: 2009 - present Added 12/05/2022 by Otis Rickman, value=Consulting fee Consultant relationship with Noah Medical Please note: 2021 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Intuitive Please note: 1/21 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: 2009 - present Added 12/05/2022 by Otis Rickman, value=Consulting fee Consultant relationship with Noah Medical Please note: 2021 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Intuitive Please note: 1/21 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: 2009 - present Added 12/05/2022 by Otis Rickman, value=Consulting fee Consultant relationship with Noah Medical Please note: 2021 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Intuitive Please note: 1/21 - present Added 12/05/2022 by Otis Rickman, source=Web Response, value=Consulting fee Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Removed 11/30/2022 by Otis Rickman, source=Web Response Consultant relationship with Medtronic/Covidien Please note: 2009 - present Added 12/05/2022 by Otis Rickman, value=Consulting fee No relevant relationships by Christopher Seder No relevant relationships by Ajaypal Singh