Esophageal Ultrasound

  • Jouke T. AnnemaEmail author


Esophageal ultrasound is a minimally invasive endoscopic technique by which mediastinal nodes and posterior mediastinal masses can be aspirated under real-time ultrasound guidance. Esophageal ultrasound is complementary to endobronchial ultrasound as it targets different areas of the mediastinum. For the diagnosis and staging of lung cancer, EUS has large impact on patient management by providing tissue proof of advanced disease or preventing more invasive surgical staging procedures. EUS is also an accurate and safe test to assess noncaseating granulomas in patients with sarcoidosis.


Mediastinal Node Left Adrenal Gland Transbronchial Lung Biopsy Aortopulmonary Window Noncaseating Granuloma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Aerts JG, Kloover J, Los J, van der Heijden O, Janssens A, Tournoy KG. EUS-FNA of enlarged necrotic lymph nodes may cause infectious mediastinitis. J Thorac Oncol. 2008;3(10):1191–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA. 2010;304(20):2245–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Annema JT, Veselic M, Versteegh MI, Willems LN, Rabe KF. Mediastinal restaging: EUS-FNA offers a new perspective. Lung Cancer. 2003;42(3):311–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Annema JT, Veselic M, Versteegh MI, Rabe KF. Mediastinitis caused by EUS-FNA of a bronchogenic cyst. Endoscopy. 2003;35(9):791–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Annema JT, Hoekstra OS, Smit EF, Veselic M, Versteegh MI, Rabe KF. Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA. Lung Cancer. 2004;44(1):53–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Annema JT, Veselic M, Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Eur Respir J. 2005;25(3):405–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Annema JT, Veselic M, Rabe KF. EUS-guided FNA of centrally located lung tumours following a non-diagnostic bronchoscopy. Lung Cancer. 2005;48(3):357–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Annema JT, Versteegh MI, Veselic M, Voigt P, Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging. J Clin Oncol. 2005;23(33):8357–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Annema JT, Versteegh MI, Veselic M, Welker L, Mauad T, Sont JK, et al. Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer. JAMA. 2005;294(8):931–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Annema JT, Bohoslavsky R, Burgers S, Smits M, Taal B, Venmans B, et al. Implementation of endoscopic ultrasound for lung cancer staging. Gastrointest Endosc. 2009;71(1):64–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Berger LP, Scheffer RC, Weusten BL, Seldenrijk CA, de Bruin PC, Timmer R, et al. The additional value of EUS-guided Tru-cut biopsy to EUS-guided FNA in patients with mediastinal lesions. Gastrointest Endosc. 2009;69(6):1045–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Bhutani MS, Hawes RH, Hoffman BJ. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc. 1997;45(6):474–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Bodtger U, Vilmann P, Clementsen P, Galvis E, Bach K, Skov BG. Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer. J Thorac Oncol. 2009;4(12):1485–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Cerfolio RJ, Bryant AS, Eloubeidi MA. Accessing the aortopulmonary window (#5) and the paraaortic (#6) lymph nodes in patients with non-small cell lung cancer. Ann Thorac Surg. 2007;84(3):940–5.PubMedCrossRefGoogle Scholar
  15. 15.
    De Leyn P, Lardinois D, Van Schil PE, Rami-Porta R, Passlick B, Zielinski M, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;32(1):1–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Detterbeck FC, DeCamp Jr MM, Kohman LJ, Silvestri GA. Lung cancer. Invasive staging: the guidelines. Chest. 2003;123(1 Suppl):167S–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Fernandez-Esparrach G, Gines A, Belda J, Pellise M, Sole M, Marrades R, et al. Transesophageal ultrasound-guided fine needle aspiration improves mediastinal staging in patients with non-small cell lung cancer and normal mediastinum on computed tomography. Lung Cancer. 2006;54(1):35–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Fritscher-Ravens A, Petrasch S, Reinacher-Schick A, Graeven U, Konig M, Schmiegel W. Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy. Respiration. 1999;66(2):150–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Gill KR, Ghabril MS, Jamil LH, Hasan MK, McNeil RB, Woodward TA, et al. Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer. Gastrointest Endosc. 2010;72(2):265–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Harewood GC, Pascual J, Raimondo M, Woodward T, Johnson M, McComb B, et al. Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer. Lung Cancer. 2009;67(3):366–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Hernandez LV, Mishra G, George S, Bhutani MS. A descriptive analysis of EUS-FNA for mediastinal lymphadenopathy: an emphasis on clinical impact and false negative results. Am J Gastroenterol. 2004;99(2):249–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Herth FJ. Mediastinal staging: the role of endobronchial and endo-oesophageal sonographic guided needle aspiration. Lung Cancer. 2004;45(Suppl 2):S63–7.Google Scholar
  23. 23.
    Herth FJ, Lunn W, Eberhardt R, Becker HD, Ernst A. Transbronchial vs transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes. Am J Respir Crit Care Med. 2005;171(10):1164–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Herth FJ, Rabe KF, Gasparini S, Annema JT. Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions. Eur Respir J. 2006;28(6):1264–75.PubMedCrossRefGoogle Scholar
  25. 25.
    Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoesophageal-endobronchial ultrasound-guided, fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Hwangbo B, Lee HS, Lee GK, Lim KY, Lee SH, Kim HY, et al. Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope. Respirology. 2009;14(6):843–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, et al. Transbronchial and transesophageal fine needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795–802.PubMedCrossRefGoogle Scholar
  28. 28.
    Kramer H, van Putten JW, Post WJ, van Dullemen HM, Bongaerts AH, Pruim J, et al. Oesophageal endoscopic ultrasound with fine needle aspiration improves and simplifies the staging of lung cancer. Thorax. 2004;59(7):596–601.PubMedCrossRefGoogle Scholar
  29. 29.
    Larsen SS, Krasnik M, Vilmann P, Jacobsen GK, Pedersen JH, Faurschou P, et al. Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management. Thorax. 2002;57(2):98–103.PubMedCrossRefGoogle Scholar
  30. 30.
    Larsen SS, Vilmann P, Krasnik M, Dirksen A, Clementsen P, Maltbaek N, et al. Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies: preliminary results from a randomised clinical trial. Lung Cancer. 2005;49(3):377–85.PubMedCrossRefGoogle Scholar
  31. 31.
    Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG. Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis. Chest. 2007;131(2):539–48.PubMedCrossRefGoogle Scholar
  32. 32.
    Rintoul RC, Skwarski KM, Murchison JT, Hill A, Walker WS, Penman ID. Endoscopic and endobronchial ultrasound real-time fine-needle aspiration for staging of the mediastinum in lung cancer. Chest. 2004;126(6):2020–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Singh P, Camazine B, Jadhav Y, Gupta R, Mukhopadhyay P, Khan A, et al. Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study. Am J Respir Crit Care Med. 2007;175(4):345–54.PubMedCrossRefGoogle Scholar
  34. 34.
    Stigt JA, Oostdijk AH, Timmer PR, Shahin GM, Boers JE, Groen HJ. Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer. Lung Cancer. 2009;66(2):198–204.PubMedCrossRefGoogle Scholar
  35. 35.
    Szlubowski A, Zielinski M, Soja J, Annema JT, Sosnicki W, Jakubiak M, et al. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging: a prospective trial. Eur J Cardiothorac Surg. 2009;37(5):1175–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Talebian M, von Bartheld MB, Braun J, Versteegh MI, Dekkers OM, Rabe KF, et al. EUS-FNA in the preoperative staging of non-small cell lung cancer. Lung Cancer. 2009;69(1):60–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Tournoy KG, Praet MM, Van Maele G, van Meerbeeck JP. Esophageal endoscopic ultrasound with fine-needle aspiration with an on-site cytopathologist: high accuracy for the diagnosis of mediastinal lymphadenopathy. Chest. 2005;128(4):3004–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Tournoy KG, De Ryck F, Vanwalleghem LR, Vermassen F, Praet M, Aerts JG, et al. Endoscopic ultrasound reduces surgical mediastinal staging in lung cancer: a randomized trial. Am J Respir Crit Care Med. 2007;177(5):531–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Tournoy KG, De Ryck F, Vanwalleghem LR, Vermassen F, Praet M, Aerts JG, et al. Endoscopic ultrasound reduces surgical mediastinal staging in lung cancer: a randomized trial. Am J Respir Crit Care Med. 2008;177(5):531–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Tournoy KG, Ryck FD, Vanwalleghem L, Praet M, Vermassen F, Maele GV, et al. The yield of endoscopic ultrasound in lung cancer staging: does lymph node size matter? J Thorac Oncol. 2008;3(3):245–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Tournoy KG, Annema JT, Krasnik M, Herth FJ, van Meerbeeck JP. Endoscopic and endobronchial ultrasonography according to the proposed lymph node map definition in the seventh edition of the tumor, node, metastasis classification for lung cancer. J Thorac Oncol. 2009;4(12):1576–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Tournoy KG, Bolly A, Aerts JG, Pierard P, De Pauw R, Leduc D, et al. The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis. Eur Respir J. 2009;35(6):1329–35.PubMedCrossRefGoogle Scholar
  43. 43.
    Tournoy KG, Keller SM, Annema JT. Mediastinal staging of lung cancer: novel concepts. Lancet Oncol. 2012;13(5):221–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Varadarajulu S, Schmulewitz N, Wildi SF, Roberts S, Ravenel J, Reed CE, et al. Accuracy of EUS in staging of T4 lung cancer. Gastrointest Endosc. 2004;59(3):345–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Varadarajulu S, Hoffman BJ, Hawes RH, Eloubeidi MA. EUS-guided FNA of lung masses adjacent to or abutting the esophagus after unrevealing CT-guided biopsy or bronchoscopy. Gastrointest Endosc. 2004;60(2):293–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Vilmann P, Annema J, Clementsen P. Endosonography in bronchopulmonary disease. Best Pract Res Clin Gastroenterol. 2009;23(5):711–28.PubMedCrossRefGoogle Scholar
  48. 48.
    von Bartheld MB, van Kralingen KW, Veenendaal RA, Willems LN, Rabe KF, Annema JT. Mediastinal-esophageal fistulae after EUS-FNA of tuberculosis of the mediastinum. Gastrointest Endosc. 2009;71(1):210–2.CrossRefGoogle Scholar
  49. 49.
    von Bartheld MB, Rabe KF, Annema JT. Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes. Gastrointest Endosc. 2009;69(2):345–9.CrossRefGoogle Scholar
  50. 50.
    Wallace MB, Block M, Hoffman BJ, Hawes RH, Silvestri G, Reed CE, et al. Detection of telomerase expression in mediastinal lymph nodes of patients with lung cancer. Am J Respir Crit Care Med. 2003;167(12):1670–5. Epub 2003 Feb 20 2003 Jun 15;167:1670–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Wallace MB, Ravenel J, Block MI, Fraig M, Silvestri G, Wildi S, et al. Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography. Ann Thorac Surg. 2004;77(5):1763–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Wallace MB, Block MI, Gillanders W, Ravenel J, Hoffman BJ, Reed CE, et al. Accurate molecular detection of non-small cell lung cancer metastases in mediastinal lymph nodes sampled by endoscopic ultrasound-guided needle aspiration. Chest. 2005;127(2):430–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA. 2008;299(5):540–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Pulmonary MedicineAcademic Medical CenterAmsterdamThe Netherlands

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