Transoesophageal endoscopic ultrasound with bronchoscope: insights from an Australian Local Health District ahead of lung cancer screening.

BACKGROUND

The combined use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transoesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is preferred in the diagnosis and staging of non-small cell lung cancer (NSCLC); however, there is limited utilisation of EUS-B-FNA in Australia. With a National Lung Cancer Screening program (NLCSP) commencing in 2025, additional diagnostics may be required by bronchoscopists.

AIMS

We describe the endoscopic model of care offered and outcomes achieved by Respiratory Physicians experienced in EUS-B-FNA practicing in a regional Australian tertiary referral hospital.

METHODS

Adult patients within the Hunter New England Local Health District (HNELDH) who underwent a diagnostic/staging EBUS-TBNA or EUS-B-FNA procedures, as recorded in a prospectively collected procedural database from 2016 to 2022, were included.

RESULTS

1564 patients (688 female), median age 68 years had a diagnostic or staging EBUS-TBNA and/or EUS-B-FNA (1268 EBUS-TBNA, 262 EUS-B-FNA and 34 combined). The diagnostic yield for procedures performed with an indication of suspected lung malignancy was as follows: EBUS-TBNA: 75.5%, EUS-B-FNA: 85.7%, and combined procedure: 61.1%. Three major infectious complications were observed in EUS-B-FNA (1.15%) and two in EBUS-TBNA (0.16%). These complications precede the institution's policy of pre-procedural antibiotic prophylaxis started in 2021.

CONCLUSION

EUS-B-FNA can be performed safely by competent EBUS-TBNA respiratory physicians provided that prospective data and complication monitoring are in place.