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Masahide Oki, MD, FCCP; Hideo Saka, MD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine, Nagoya Medical Center.

CORRESPONDENCE TO: Masahide Oki, MD, FCCP, Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan; e-mail: masahideo@aol.com


CONFLICT OF INTEREST: None declared.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):e130. doi:10.1378/chest.15-1457
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To the Editor:

We thank Dr Meena and colleagues for their genuine interest regarding our study in CHEST1 and especially for encouraging the use by pulmonologists of transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with an endobronchial ultrasound (EBUS) scope. In our study setting for the diagnosis of lesions accessible through both the airway and the esophagus, EUS-FNA with an EBUS scope had the advantages of comparable tolerance with fewer doses of anesthetics and sedatives, shorter procedure time, less oxygen desaturation, less coughing, and greater operator satisfaction compared with EBUS-guided transbronchial needle aspiration (EBUS-TBNA).1 In our study, these two procedures provided comparable diagnostic yields; therefore, EUS-FNA can be selected as an alternative procedure to EBUS-TBNA. The performance of EUS-FNA by pulmonologists seems to be a reasonable way to provide the optimal procedure in individual patients.

The great advantage of EUS-FNA is its accessibility to areas inaccessible by EBUS-TBNA. EUS-FNA allows easy access to posteroinferior mediastinal lesions and, in some cases, it may evaluate subaortic lymph nodes2 or left adrenal glands, as Dr Meena and colleagues have suggested. In addition, EUS-FNA may provide diagnostic benefit even for lesions adjacent to the trachea, which are considered accessible by EBUS-TBNA.3 Indeed, although to varying degrees, studies on the EBUS-TBNA and EUS-FNA with a single EBUS scope have demonstrated that the sensitivity of the combined procedure is higher than that of each technique alone.2,4 Thus, the role of EUS-FNA with an EBUS scope is complementary, as well as an ideal alternative, to EBUS-TBNA. Again, the use of EUS-FNA by pulmonologists who manage the patient and perform EBUS-TBNA for lung cancer staging seems to be practical.

In future, EUS-FNA, as well as EBUS-TBNA, may become indispensable procedures for pulmonologists. In fact, the recent guideline4 recommends that endoscopists who perform endosonographic staging of lung cancer should be trained in both EBUS-TBNA and EUS-FNA with an EBUS scope. As Mehta et al5 described, “proper training” is necessary to ensure satisfactory results and safety. We hope that a proper training method will be established and included in the bronchoscopy training curriculum for pulmonologists.

References

Oki M, Saka H, Ando M, et al. Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study. Chest. 2015;147(5):1259-1266. [CrossRef] [PubMed]
 
Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: are two better than one in mediastinal staging of non-small cell lung cancer? J Thorac Cardiovasc Surg. 2014;148(4):1169-1177. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, Sato S. Bronchoscopic transesophageal ultrasound-guided needle aspiration: an alternative to the conventional transesophageal ultrasound-guided needle aspiration technique. J Thorac Cardiovasc Surg. 2010;139(6):1659-1661. [CrossRef] [PubMed]
 
Vilmann P, Clementsen PF, Colella S, et al. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy. 2015;47(6):545-559. [CrossRef] [PubMed]
 
Mehta AC, Cicenia J, Yasufuku K. The chef has a knife…: endoscopic ultrasound-guided fine-needle aspiration by a pulmonologist. Chest. 2015;147(5):1201-1203. [CrossRef] [PubMed]
 

Figures

Tables

References

Oki M, Saka H, Ando M, et al. Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study. Chest. 2015;147(5):1259-1266. [CrossRef] [PubMed]
 
Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: are two better than one in mediastinal staging of non-small cell lung cancer? J Thorac Cardiovasc Surg. 2014;148(4):1169-1177. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, Sato S. Bronchoscopic transesophageal ultrasound-guided needle aspiration: an alternative to the conventional transesophageal ultrasound-guided needle aspiration technique. J Thorac Cardiovasc Surg. 2010;139(6):1659-1661. [CrossRef] [PubMed]
 
Vilmann P, Clementsen PF, Colella S, et al. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy. 2015;47(6):545-559. [CrossRef] [PubMed]
 
Mehta AC, Cicenia J, Yasufuku K. The chef has a knife…: endoscopic ultrasound-guided fine-needle aspiration by a pulmonologist. Chest. 2015;147(5):1201-1203. [CrossRef] [PubMed]
 
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