IDDF2022-ABS-0137 Application of endoscopic ultrasound EUS in evaluation of mediastinal lesions

Background

Endoscopic Ultrasound (EUS) has emerged as a useful tool to obtain tissue acquisition for diagnosis. In mediastinology, EUS plays its supportive role in certain areas in mediastinum to obtain via trans-oesophageal route safely and accurately tissue diagnosis from lesions suspected likely malignancy either lung pathologies or metastasis from other primaries. In third-world countries, tuberculosis is also commonly encountered along with it. We share our initial experience of different pathologies encountered in EUS-guided biopsy of mediastinal lesions.

Methods

A total of 21 cases underwent EUS guided Biopsy from June 2020 to June 2022. Informed consent was obtained, and with Covid screen test with PCR was performed before the procedure. Procedures were done with all SOPs as per institutional guidelines. 22G FNB needle in 20 cases and 25G in one case; Franseen design with the capillary suction method was used to obtain visible core samples for histopathology without Rapid-Onsite-Evaluation (ROSE). All cases have adequate sample for histological diagnosis. The post-procedure oral antibiotic was given to all patients.

Results

Among these cases, 13 were male, with a mean age of 55 years (range 22–87) and a mean duration of procedure 21 minutes (10–35 min). Majority of them; 12 cases were malignant pathologies, while the remaining 09 were benign. The number of ‘passes’ with the needle was average 2.5 with single pass 02, two pass 10, three passes 05 and multitarget lesions were 04. There were Mediastinal lesions in 16 cases and mediastinal nodes biopsy in 05 cases. Common tissue diagnoses include Tuberculosis 06, Squamous cell Carcinoma 04, Lymphoma 03, Benign in 02, Sarcomatoid carcinoma 02 and Metastatic renal Cell Carcinoma 01, Metastatic breast 01, Sarcoidosis 01, Solitary fibrous tumour 01. There were no immediate or early complications in all cases.

Conclusions

EUS-guided biopsy of lesions in different mediastinal areas is safe and provides tissue diagnosis with high diagnostic accuracy with the use of FNB needles.