Which procedure is commonly used to access mediastinal lymph nodes that may require sampling when PET is positive, and can be performed via the airway with ultrasound guidance?

Which procedure is commonly used to access mediastinal lymph nodes that may require sampling when PET is positive, and can be performed via the airway with ultrasound guidance?

• A. Mediastinoscopy and EBUS
• B. Bronchoscopy
• C. Pleural biopsy
• D. VATS

Answer: (A)

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the procedure that matches this scenario. It is done through the airway with an endobronchial ultrasound probe, which lets the clinician see mediastinal lymph nodes in real time and then guide a needle through the bronchial wall into the node to obtain tissue. This approach is particularly useful when PET imaging shows uptake in mediastinal nodes, because it provides definitive tissue diagnosis to confirm nodal involvement and guide staging and treatment. It is minimally invasive compared with surgical mediastinoscopy, has a high diagnostic yield for mediastinal lymph nodes, and carries a lower risk and quicker recovery. If certain nodes are not accessible with EBUS, additional approaches such as endoscopic ultrasound or surgical sampling can be considered, but the airway-based ultrasound-guided sampling is the common first-line method.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the procedure that matches this scenario. It is done through the airway with an endobronchial ultrasound probe, which lets the clinician see mediastinal lymph nodes in real time and then guide a needle through the bronchial wall into the node to obtain tissue.

This approach is particularly useful when PET imaging shows uptake in mediastinal nodes, because it provides definitive tissue diagnosis to confirm nodal involvement and guide staging and treatment. It is minimally invasive compared with surgical mediastinoscopy, has a high diagnostic yield for mediastinal lymph nodes, and carries a lower risk and quicker recovery.

If certain nodes are not accessible with EBUS, additional approaches such as endoscopic ultrasound or surgical sampling can be considered, but the airway-based ultrasound-guided sampling is the common first-line method.