Endosonography for lung cancer staging

Endosonography is a minimally invasive and safe, but also challenging procedure that has been positioned as the first line nodal tissue staging procedure for lung cancer. In this thesis, it has been shown that the concept of one (EBUS – endobronchial ultrasound) scope, single operator, systematic endobronchial and esophageal approach to evaluate all loco-regional lymph nodes and the left adrenal gland in the same session, might qualify as the optimal way to stage lung cancer patients. A structured ERS (European Respiratory Society) training program to educate and train bronchoscopists to be able to independently and competently perform EBUS has been developed and may facilitate this objective. Despite promising developments in imaging modalities, smart needles (like optical coherence tomography and needle based confocal laser endomicroscopy) and tumor labeling, the largest improvement for accurate nodal staging will probably be achieved by adequate education and training of pulmonologists

EBUS versus EUS-B for diagnosing sarcoidosis: the International Sarcoidosis Assessment (ISA) randomized clinical trial

Background and objective: Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head-to-head comparison of both routes has never been performed.Methods: Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)-B-guided nodal sampling, and to 22- or 25-G ProCore needle aspiration (2 x 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow-up at 6 months.Results: A total of 358 patients were randomized: 185 patients to EBUS-transbronchial needle aspiration (EBUS-TBNA) and 173 to EUS-B-fine-needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63-76) for EBUS-TBNA and 68% (118/173; 95% CI, 61-75) for EUS-B-FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71-84) for EBUS-TBNA and 82% (115/141; 95% CI, 74-87) for EUS-B-FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity.Conclusion: Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS-B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients.Pathogenesis and treatment of chronic pulmonary disease