CRA22 ENDOSCOPIC ULTRASOUND WITH BRONCHOSCOPE GUIDED TRANSESOPHAGEAL CRYOBIOPSY: A NOVEL APPROACH TO MEDIASTINAL BIOPSY

Chun Ian Soo1
1. Division of Respiratory medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia

Introduction

Endobronchial ultrasound (EBUS) and endoscopic ultrasound with bronchoscope (EUS-B) are well-established modalities for the diagnosis and staging of lung cancer. An increasing number of reports have described the use of EBUS-guided transmediastinal cryobiopsy (EBUS-TMC). However, EUS-B-guided transesophageal cryobiopsy (EUS-B-TEC) is a novel approach that has been documented in only two previous instances. Herein, we present the largest case series to date. All procedures were successfully conducted without any complications. 

Case series  

Case 1: A 72-year-old male presented with cough for six months and a large left-sided lung mass (7.80 x 6.30 cm) on CT. Due to critical occlusion of the left main bronchus, EUS-B-TEC was conducted and confirmed small cell lung carcinoma. The patient was commenced on chemotherapy. 

Case 2: A 65-year-old male presented with cough and a 10kg weight loss for three months. He has a 100 packed-year smoking history. A CT thorax showed a right hilar mass (2.51x3.15 cm) with multiple mediastinal lymph nodes. EUS-B-TEC was performed on station 4L LN due to poor tolerance to EBUS-TBNA and TMC on 4R LN. Targeted treatment was commenced after all samples confirmed metastatic lung adenocarcinoma.

Case 3: A 42-year-old male with history of nasopharyngeal carcinoma developed a left lower lobe lung adenocarcinoma. EBUS and EUS-B were performed for complete mediastinal staging. Biopsy samples from stations 11R, 7, and 4L LNs were all negative for malignancy; consistent with a mediastinoscopy findings conducted later. The patient is scheduled for a curative lung resection. 

Case 4: A 35-year-old male with type 2 muscular dystrophy presented with intermittent fever and cough for six months. He had multiple enlarged mediastinal lymph nodes. EUS-B was favored over EBUS to avoid ventilation compromise. Four EUS-B-FNA and TEC were performed on 4L LN. Results were consistent with mycobacterium tuberculosis infection. 

Conclusion 

Is feasible and safe for experienced pulmonologist to conduct advance EUS-B-TEC.