• Basil S Nasir, Marcel Edwards, Vicky Tiffault, Jordan Kazakov, Mohammed Khereba, Pasquale Ferraro, and Moishe Liberman.
• CHUM Endoscopic Tracheo-bronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
• J. Thorac. Cardiovasc. Surg.. 2014 Sep 1;148(3):850-5; discussion 855.

ObjectiveParenchymal pulmonary nodules located in proximity to the mediastinum, vertebral column, major vessels, or behind the heart can be technically challenging and dangerous to biopsy using traditional image-guided techniques. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can be used to access some of these difficult to reach lesions. The purpose of the present study was to report our experience with this technique in a consecutive cohort of selected patients.MethodsThis was a retrospective cohort study. Eligible patients were identified from a prospective database. A transesophageal approach under real-time EUS guidance was performed using a 22-gauge needle. All patients underwent postprocedural chest radiography and were followed up at 30 days.ResultsDuring a 31-month period, 55 patients underwent EUS-guided lung biopsy. Confirmatory visual correlation of nodule localization within the lung parenchyma between computed tomography and EUS was possible in 100% of cases. The lung nodule distribution was 41.5% right upper lung, 18.9% right lower lung, 28.3% left upper lung, and 11.3% left lower lung. Histologic and cytologic sampling was adequate in 52 of the 55 procedures (94.5%). In all patients with adequate biopsy sampling, accurate pathocytologic diagnoses of the target parenchymal nodules were obtained. The accuracy and sensitivity of EUS-FNA were both 94.5% and consistent with the diagnosis on pathologic resection or clinical progression of disease, or both. No morbidity resulted from the procedure nor was observed at 30 days.ConclusionsEUS-FNA of parenchymal pulmonary nodules is safe and accurate and allows for biopsy of perimediastinal lung lesions not attainable using traditional techniques.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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