Ultrasonography of the mediastinum: Techniques, current practice, and future directions

Leonello Fuso, Francesco Varone, Daniele Magnini, Mariarosaria Calvello, Erminia Lo Greco, Luca Richeldi

Research output: Contribution to journalArticlepeer-review

Abstract

In the everyday practice of respiratory physicians, ultrasound techniques play a key role by enabling several diagnostic and interventional procedures. The application of ultrasound to endoscopic procedures allows both a visualization and a guided sampling of mediastinal and hilar lymph nodes. Endobronchial ultrasound can be combined with transbronchial needle aspiration, and, similarly, endoscopic ultrasound can be combined with fine-needle aspiration to sample virtually all mediastinal nodal stations from the airways and the esophagus. Endobronchial ultrasound–transbronchial needle aspiration and endoscopic ultrasound–fine needle aspiration showed a complementary diagnostic yield, and, recently, endoscopic ultrasound with bronchoscope was introduced in clinical practice to perform a transesophageal needle aspiration by using an ultrasound bronchoscope. This technique allows a single operator to perform both transbronchial and transesophageal needle sampling with the same instrument during a single bronchoscopic procedure. Mediastinal staging impacts the management of patients affected by lung cancer, and the most recent guidelines clearly state that endobronchial ultrasound and endoscopic ultrasound should be the initial tissue sampling procedure over surgical staging. In addition, endoscopic ultrasound techniques demonstrated an excellent yield in diagnosing lymphoma and benign diseases, for example, sarcoidosis. The aim of this review was to discuss the current role and future perspectives of endosonography techniques available for the evaluation of the mediastinum. Special emphasis was placed on equipment and technical aspects, the diagnostic role, and future directions of development.

Original languageEnglish
Pages (from-to)1421-1438
Number of pages18
JournalRespiratory Care
Volume63
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • EBUS needle injection therapy
  • EBUS-TBNA
  • Endosonography
  • EUS-FNA
  • Lung cancer staging
  • Lymphoma
  • Mediastinal lymph nodes
  • Sarcoidosis
  • Simulator-based training

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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