OUTSPREADING THE BORDERS OF INTERVENTIONAL PULMONOLOGY: THE EVER-GROWING APPLICATIONS OF COMBINED EBUS/EUS-B

Abstract

TYPE: Late Breaking Abstract TOPIC: Procedures INTRODUCTION: Interventional pulmonary disposes of echoendoscopic techniques that can be used in a tracheal or esophageal route, with great impact on the diagnosis and staging of lung cancer. Other diagnostic potentialities are also possible, although there are still few reports described in the literature. CASE PRESENTATION: A 62-year-old female smoker presented a spiculated nodule in the posterior segment of the left upper lobe and another adjacent to the anterior wall of the gastric body. She was scheduled to perform endoscopic examination under general anaesthesia. No endobronchial abnormalities were detected through conventional bronchoscopy. The pulmonary nodule was accessed by radial endobronchial ultrasound (EBUS) and transbronchial biopsy was performed. The heterogeneous abdominal nodule was approached via esophageal EBUS (EUS-B) needle aspiration. A structured EUS assessment of six landmarks was also performed. No complications were recorded. The pathology report described coexistence of lung adenocarcinoma and gastrointestinal stromal tumour. DISCUSSION: This case highlights the success of radial EBUS in peripheral pulmonary nodules without endobronchial involvement and the added benefit of the endobronchial bronchoscope that can also be passed into the esophagus and stomach, thereby allowing adjacent structures to be sampled. The combination of these techniques allowed the prompt diagnosis of an uncommon event of two synchronous tumours. CONCLUSIONS: EUS-B is complementary to EBUS and is well suited in the hands of a trained pulmonologist. These techniques have shown that most of the previous limitations can be overcome in a single session, by one operator and with a high diagnostic yield, thereby decreasing healthcare cost, time delays and patient discomfort. DISCLOSURE: No significant relationships. KEYWORD: Diagnosis; Combined endoscopic-endobronchial ultrasound-guided transbronchial needle aspiration