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Why Respiratory Physicians Should Learn and Implement EUS-FNA

With regard to our recent editorial (1), we thank Drs. Annema and Rabe for their letter, which takes up the issue that we hoped to raise, namely, that transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) should not be a separate procedure, but an integral part in the staging algorithm of lung cancer. Most patients with suspected lung cancer have a staging computed tomography (CT) of the thorax and upper abdomen as their initial investigation. Following this, the appropriate diagnostic and staging investigation is planned. If the potential for performing EUS-FNA is available to the bronchoscopist, it becomes just another approach together with bronchial biopsy itself and endobronchial ultrasound-guided fine needle aspiration (EBUS). The aim is to shorten the patient's pathway and enable the endoscopist to perform the most appropriate test dependent on the patient's presentation.

It does seem to make good sense for respiratory physicians to be trained in ultrasound-guided techniques, even if this may be only realistic in cancer or tertiary referral centers. It is probable that the majority of patients can be staged at bronchoscopy plus transbronchial needle aspiration (TBNA) or EBUS, but in those patients for whom EUS may be the procedure of choice, it seems logical for one trained individual to have the skill to do any of these investigations. A respiratory physician with a special interest in lung cancer and knowledge of the lymph node mapping (staging) system should be that person.

These techniques should be incorporated into international guidelines for the management of lung cancer. This would, in turn, be helpful in enabling physicians working in state-run systems to purchase this equipment and, by doing so, save healthcare providers considerable sums of money.

Stephen G. Spiro

University College London Hospitals, London, United Kingdom

Sam Janes

University College London, London, United Kingdom

FOOTNOTES

Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Janes SM, Spiro SG. Esophageal endoscopic ultrasound/endobronchial ultrasound-guided fine needle aspiration— a new dawn for the respiratory physician? [editorial] Am J Respir Crit Care Med 2007;175:297–299.[Free Full Text]

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