EUS-B-FNA vs EUS-FNA for left adrenal gland analysis in lung cancer patients

Abstract

Introduction: The adrenal glands are predilection sites for distant metastases (M1b) in patients with lung cancer. However, even in a lung cancer setting, enlarged adrenal glands are more likely to be benign than malignant and therefore tissue sampling is indicated to either confirm or rule out metastases. Sampling is regularly performed by a transgastric endoscopic approach using a conventional GI-EUS scope. Whether the left adrenal gland (LAG) can also be sampled with the EBUS scope (EUS-B) is unknown. Aim: Investigate the success rate (defined as feasible to detect, sample and obtain adequate material for cytopathological evaluation) of EUS-B-FNA vs EUS-FNA for LAG analysis in patients with (suspected) lung cancer and a suspected LAG on (CT/ PET) imaging. Method: Prospective, international, multicenter study of lung cancer patients who underwent LAG analysis by EUS-B (using the EBUS scope) followed by conventional EUS. Clinical and radiological follow-up or surgical verification was used as the reference standard. Results: 44 patients underwent EUS-B followed by EUS. The proportion of patients with a successful EUS-B-FNA and EUS-FNA procedure for LAG analysis was 89% (n=39) and 93% (n=41) respectively. The prevalence of LAG metastasis was at least 48% (21/44) (follow-up data are pending). No SAE9s occurred. Conclusion: LAG analysis using the EBUS scope (EUS-B) is feasible and results in similar outcomes using the conventional EUS scope. Implication: In addition to mediastinal nodal staging, LAG analysis can also be performed using the EBUS scope.