6. Endoscopic ultrasound-guided fine-needle aspiration in the staging of lung cancer
Mohamad A. Eloubeidi
Fig. 1 American Thoracic Society classification of various nodal stations on patients with lung cancer. Note that due to the proximity
of the esophagus to the posterior mediastinum, EUS-FNA is the best approach to evaluate the subcarina (station 7), periesophageal
stations (level 8 and 9), the aortopulmonary window (station 5), and the left adrenal gland via the transgastric approach.
Fig. 2 Operating characteristics of EUS-FNA in mediastinal adenopathy in patients with lung cancer.
Fig. 3 (A) normal 'seagull' appearance to the left adrenal gland. (B) EUS-guided fine-needle aspiration of left adrenal gland documenting metastatic
disease in a patient with non-small cell lung cancer, precluding surgery. PA and LA denote pulmonary artery and left atrium,
respectively. (Olympus UC-30 P scanning at 5 MHz.)
Fig. 4 Echoendoscope placed in the mid-esophagus allows imaging of a lymph node of the subcarina. (Circle at 12 o'clock in the image
is the ultrasound transducer.) EUS-FNA confirmed malignant involvement. (Olympus UC-30 P scanning at 5 MHz).
Fig. 5 Curved linear array EUS echoendoscope (upper) and endobronchial echoendoscope (EBUS, lower instrument).
Fig. 6 EBUS image of malignant anterior (precarinal) lymph node, confirmed on EBUS-FNA in a patient with non-small cell lung cancer.
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