ABSTRACT

Tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging. Non-invasive imaging techniques (CT, MRI, PET and PET-CT) help but do not provide tissue diagnosis. TBNA is a safe procedure that can be performed during routine bronchoscopy. Unfortunately, it remains underutilized in current practice, mainly due to the lack of real-time needle visualization. The introduction of echo-endoscopes has overcome this problem. Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal nodes located adjacent to the esophagus can be assessed by transesophageal ultrasound- guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging, can be achieved by the combination of both procedures. It is expected that the implementation of minimally invasive endoscopic methods (EBUS-TBNA and EUS-FNA) will reduce the need for surgical staging of lung cancer significantly. The aim of this review is to present the subject to the Latin-American medical community since these procedures are starting to be performed in our region.

KEYWORDS

transbronchial needle aspiration, endobronchial ultrasound, endoesofagic ultrasound, lung cancer, endoscopic mediastinal staging.

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