Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes.

BACKGROUND Obtaining tissue from a para-aortal lymph node or tumor is a challenge that currently requires invasive surgical procedures. Para-aortic lung tumors can be clearly visualized by EUS. Although the accessibility of lesions adjacent to the esophagus is well documented, the para-aortic region has never been systematically explored. OBJECTIVE To assess the feasibility, yield, and safety of transaortic biopsy specimens in the diagnosis of lung tumors and nodal masses located lateral to the aorta. DESIGN A retrospective case series of 14 consecutive patients. SETTING Pulmonary Department, Leiden University Medical Center, Leiden, The Netherlands. PATIENTS Fourteen patients with known or suspected lung cancer. Nine patients presented with a left-sided lung mass (mean size 27 mm), whereas 5 patients had an enlarged para-aortic node (mean size 16 mm). INTERVENTIONS Real-time EUS-guided transaortic biopsy of a para-aortic lesion. MAIN OUTCOME MEASUREMENTS Feasibility, diagnostic yield, and complication rates of transaortic EUS-guided FNA (EUS-FNA). RESULTS The final diagnosis was known in 12 patients (10 non-small-cell lung carcinoma [NSCLC], 1 small-cell lung carcinoma [SCLC], and 1 renal-cell carcinoma). EUS-FNA established malignancy in 9 of 14 patients (64%) (8 NSCLC and 1 SCLC). One aspirate revealed reactive nodal tissue, and 4 demonstrated nonrepresentative material. Malignancy was further assessed in 3 patients after subsequent diagnostics. Transaortic FNA was found to be safe. In 2 patients, EUS images after biopsy were suspicious for a small para-aortic hematoma. These patients recovered uneventfully. CONCLUSIONS These results demonstrate that a single EUS-guided transaortic biopsy of para-aortic lymph nodes and tumors is a feasible and probably safe method that results in a diagnosis in the majority of cases.