Advances in lung cancer diagnosis and staging: endobronchial ultrasound.

BACKGROUND: Endobronchial ultrasound (EBUS) is an accurate and relatively less invasive procedure for the diagnosis of lung lesions and mediastinal lymph node staging for lung cancer. We aimed to evaluate the clinical utility and safety of this new EBUS service established in our hospital. METHODS: Consecutive patients who underwent EBUS-transbronchial lung biopsy (EBUS-TBLB) for biopsy of peripheral pulmonary lesions or for transbronchial needle aspiration (TBNA) of mediastinal lymph node enlargement were included in this audit. Demographic and clinical data were obtained prospectively. Diagnostic yield from the results of EBUS was compared to other clinical information obtained. RESULTS: Thirty-eight patients underwent EBUS over a 10-month period. The yield from EBUS-TBLB was 62%. The average size of the lung lesions biopsied was 3.5 cm and 62% were located in the upper lobes. Malignancy was diagnosed in 14 cases and a benign aetiology in four. The yield from EBUS-TBNA was 88% and the average size of the lymph nodes was 2.3 cm. The lymph nodes were all located in the subcarinal station except for two that were in the lower paratracheal station. Malignancy was diagnosed in 10 cases on TBNA and 4 cases had benign pathology. There was one complication seen (small pneumothorax). CONCLUSION: EBUS is safe and an effective method for both, diagnosis of peripheral pulmonary lesions and staging for lung cancer.

Maneuver to assist examination of the hypopharynx.

BACKGROUND: The lower hypopharynx, lying posterior to the larynx, is not usually assessable during outpatient examination. A maneuver was developed to assist flexible endoscopic examination of this region. The discomfort experienced by fifty consecutive patients undergoing the maneuver was assessed together with the view obtained. METHOD: Fifty patients assigned scores from 0 to 10 to the discomfort experienced during manual anterosuperior traction applied to the prelaryngeal skin, together with two other commonly performed procedures. The view obtained in the last 30 patients was assessed. RESULTS: The mean discomfort score for the maneuver was 3.77, compared with 3.84 and 5.94 for the other two procedures. A view to the cricoarytenoid joint or below was obtained in 60% of the patients assessed. CONCLUSIONS: We conclude that the maneuver is well tolerated and results in a useful view of the hypopharynx in the majority of patients. No prior report of this maneuver has been found in the literature.