Endosonographic Lymph Node Staging by Combined Endobronchial Ultrasound (EBUS) and Endoscopic Ultrasound: Technique and Technical Tricks

Abstract

Surgical staging by mediastinoscopy has been considered the gold standard for staging of the mediastinum in non–small cell lung cancer for many years; however, more recently, minimally invasive endosonographic procedures using combined endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) have replaced mediastinoscopy as the method of choice for mediastinal lymph node evaluation. A combination of EBUS and EUS performed in a single setting has been shown to have results comparable to surgical staging and increased yield in comparison with each procedure alone. It is actually superior to surgical mediastinal staging due to its ability to access lymph nodes out of the range of traditional surgical techniques. Correct identification of the mediastinal lymph node stations with endosonography requires knowledge of each lymph node station's ultrasonic anatomical positions and relationships. The aim of this paper is to describe to the reader how combined endosonographic techniques are performed, breaking up, and detailing each of the steps.