2023 年 1 巻 2 号 p. 58-64
Background: Optimal management of lung cancer requires an accurate diagnosis and a safe and comfortable examination method allowing acceptable rebiopsy. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is associated with lesser pain than endoscopic ultrasound-guided fine-needle aspiration but has the same diagnostic ability for mediastinal lesions as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Thus, it has become increasingly popular among respiratory endoscopists. However, studies on the utility and diagnostic yield of EUS-B-FNA for neoplastic lesions inside and outside the lung adjacent to the esophagus are limited. Thus, this study aimed to investigate the utility of EUS-B-FNA for diagnosing neoplastic lesions inside and outside the lung adjacent to the esophagus.
Materials and Methods: We retrospectively reviewed 47 consecutive patients who underwent EBUS-TBNA or EUS-B-FNA for neoplastic lesions inside and outside the lung adjacent to the esophagus at Hakodate Goryoukaku Hospital between July 2019 and November 2021. The following factors were analyzed: diagnostic rates; cumulative doses of lidocaine, midazolam, and fentanyl; patient satisfaction evaluated with a questionnaire survey; and procedural complications.
Results: The diagnostic rates with EBUS-TBNA and EUS-B-FNA were 70.0% (14/20) and 96.3% (26/27), respectively. The median dose of midazolam (16.5 mg vs. 14 mg; P = 0.017) and lidocaine (240 mg vs. 32 mg; P < 0.001) was significantly low with EUS-B-FNA. The mean level of discomfort during bronchoscopy was significantly low in EUS-B-FNA (2.25 vs. 1.56; P = 0.025).
Conclusions: Although EUS-B-FNA differs from EBUS-TBNA in some diagnostic areas, EUS-B-FNA for neoplastic lesions inside and outside the lung adjacent to the esophagus has a higher diagnostic rate and examination comfort. Mastering EUS-B-FNA may improve the diagnostic capabilities of respiratory endoscopists.
