- Email: [email protected]
Endobronchial Ultrasound and Esophageal Ultrasound: Response
severe cough, dyspnea, cardiac problems, or other conditions.4 However, dedicated training in transesophageal examination procedures is mandatory.
Response To the Editor: We thank Dr Wang and colleagues for their thoughtful comments on our recent article.1 Our study showed the usefulness of endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) following endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of potentially operable lung cancer. We agree that caution is needed in the use of EUS-B-FNA in clinical practice. Many bronchoscopists have not been trained in upper-GI endoscopic procedures and are not familiar with mediastinal ultrasound images observed from the esophagus. Our study showed that accessibility to the mediastinum was greater with the transbronchial approach than with the transesophageal approach. Therefore, examination of the mediastinum with EUS-B-FNA after examination with EBUS-TBNA provided additional diagnostic information in a relatively small group of patients. Among 45 patients who were finally confirmed to have mediastinal metastasis, the stage for three was raised to N2 disease after use of the transesophageal procedure. EUS-B-FNA following EBUS-TBNA can be useful when lesions are accessible only by EUS-B-FNA and when the status of the target can change the treatment plan. The use of an ultrasound bronchoscope in the esophagus broadens the number of choices of endoscopic procedures in mediastinal staging. Conventional endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is traditionally performed by gastroenterologists. The advantages of respiratory physicians performing EUS-FNA in lung cancer staging have been discussed.2,3 Availability of the EUS-B-FNA procedure may change the approach used by bronchoscopists to stage lung cancer. We evaluated the additional gain provided by EUS-B-FNA when done after EBUS-TBNA. However, EUS-B-FNA can be used as a first-line examination method in a combined EBUS-EUS approach. EUS-FNA is a better-tolerated procedure than EBUS-TBNA. EUS-B-FNA can be readily coupled with bronchoscopic procedures when bronchoscopy is difficult because of
www.chestpubs.org
Bin Hwangbo, MD, PhD Hyae-Young Kim, MD, PhD Geon-Kook Lee, MD, PhD Jae Ill Zo, MD, PhD Goyang, Korea Affiliations: From the Center for Lung Cancer, National Cancer Center. Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Correspondence to: Bin Hwangbo, MD, PhD, Center for Lung Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Korea; e-mail: [email protected] © 2011 American College of Chest Physicians. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/ site/misc/reprints.xhtml). DOI: 10.1378/chest.11-0754
References 1. Hwangbo B, Lee G-K, Lee HS, et al. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802. 2. Janes SM, Spiro SG. Esophageal endoscopic ultrasound/ endobronchial ultrasound-guided fine needle aspiration: a new dawn for the respiratory physician? Am J Respir Crit Care Med. 2007;175(4):297-299. 3. Annema JT, Rabe KF. Why respiratory physicians should learn and implement EUS-FNA. Am J Respir Crit Care Med. 2007;176(1):99. 4. Hwangbo B, Lee HS, Lee GK, et al. Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope. Respirology. 2009;14(6):843-849.
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Response To the Editor: We thank Dr Wang and colleagues for their thoughtful comments on our recent article.1 Our study showed the usefulness of endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) following endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of potentially operable lung cancer. We agree that caution is needed in the use of EUS-B-FNA in clinical practice. Many bronchoscopists have not been trained in upper-GI endoscopic procedures and are not familiar with mediastinal ultrasound images observed from the esophagus. Our study showed that accessibility to the mediastinum was greater with the transbronchial approach than with the transesophageal approach. Therefore, examination of the mediastinum with EUS-B-FNA after examination with EBUS-TBNA provided additional diagnostic information in a relatively small group of patients. Among 45 patients who were finally confirmed to have mediastinal metastasis, the stage for three was raised to N2 disease after use of the transesophageal procedure. EUS-B-FNA following EBUS-TBNA can be useful when lesions are accessible only by EUS-B-FNA and when the status of the target can change the treatment plan. The use of an ultrasound bronchoscope in the esophagus broadens the number of choices of endoscopic procedures in mediastinal staging. Conventional endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is traditionally performed by gastroenterologists. The advantages of respiratory physicians performing EUS-FNA in lung cancer staging have been discussed.2,3 Availability of the EUS-B-FNA procedure may change the approach used by bronchoscopists to stage lung cancer. We evaluated the additional gain provided by EUS-B-FNA when done after EBUS-TBNA. However, EUS-B-FNA can be used as a first-line examination method in a combined EBUS-EUS approach. EUS-FNA is a better-tolerated procedure than EBUS-TBNA. EUS-B-FNA can be readily coupled with bronchoscopic procedures when bronchoscopy is difficult because of
www.chestpubs.org
Bin Hwangbo, MD, PhD Hyae-Young Kim, MD, PhD Geon-Kook Lee, MD, PhD Jae Ill Zo, MD, PhD Goyang, Korea Affiliations: From the Center for Lung Cancer, National Cancer Center. Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Correspondence to: Bin Hwangbo, MD, PhD, Center for Lung Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Korea; e-mail: [email protected] © 2011 American College of Chest Physicians. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/ site/misc/reprints.xhtml). DOI: 10.1378/chest.11-0754
References 1. Hwangbo B, Lee G-K, Lee HS, et al. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802. 2. Janes SM, Spiro SG. Esophageal endoscopic ultrasound/ endobronchial ultrasound-guided fine needle aspiration: a new dawn for the respiratory physician? Am J Respir Crit Care Med. 2007;175(4):297-299. 3. Annema JT, Rabe KF. Why respiratory physicians should learn and implement EUS-FNA. Am J Respir Crit Care Med. 2007;176(1):99. 4. Hwangbo B, Lee HS, Lee GK, et al. Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope. Respirology. 2009;14(6):843-849.
CHEST / 140 / 1 / JULY, 2011
Downloaded from chestjournal.chestpubs.org by Kimberly Henricks on July 6, 2011 © 2011 American College of Chest Physicians
273