Left adrenal gland analysis using the EBUS scope: A feasibility study in lung cancer patients

Abstract

Introduction: In lung cancer patients, the left adrenal gland (LAG) is a predilection site for distant metastases. Esophageal endoscopic ultrasound (EUS) - using a conventional GI endoscope - is an accurate method to obtain tissue from the LAG. Complete mediastinal nodal staging can be achieved by the combination of EBUS and EUS using a single EBUS scope by introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. Aim: To investigate the feasibility to detect the LAG with an EBUS scope. Method: Retrospective analysis of NSCLC patients who underwent EUS-B using the EBUS scope for mediastinal staging and LAG assessment in 2013-2014. Results: 68 patients with (suspected) lung cancer were investigated in supine position. In 58/68 patients (85%), the LAG was clearly visualized. In 4 patients, with an abnormal shaped adrenal body on EUS-B imaging, aspirates revealed normal adrenal gland (n=3) and a metastasis (n=1). In 10 patients, the LAG was not found due to poor contact between the ultrasound transducer and stomach wall (n=8) and shortness of the endoscope (n=2). Conclusion: The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. Implication: Left adrenal gland analysis using an EBUS scope seems feasible. Prospective studies using EUS-B for LAG assessment - including fine needle aspiration (FNA) - are indicated.