Transesophageal endoscopic ultrasound-guided tissue acquisition of lung masses: a case series with systematic review and meta-analysis

BACKGROUND: The diagnosis of intraparenchymal lung masses is challenging when lesions are located at sites inaccessible through bronchoscopy or endobronchial ultrasound. Endoscopic ultrasound (EUS)-guided tissue acquisition (TA)—fine-needle aspiration (FNA) or fine-needle biopsy—provides a potentially useful diagnostic tool for lesions located adjacent to the esophagus. This study was conducted to analyze the diagnostic outcome and safety of EUS-guided tissue sampling of lung masses. METHODS: Data were retrieved for patients who underwent transesophageal EUS-guided TA between May 2020 and July 2022 at 2 tertiary care centers. A meta-analysis was performed after pooling these data with studies obtained from a comprehensive search of Medline, Embase, and ScienceDirect from January 2000 to May 2022. Pooled event rates across studies were expressed with summative statistics. RESULTS: After screening, 19 studies were identified and, after their data had been combined with those of 14 patients from our centers, a total of 640 patients were included in the analysis. The pooled rate of sample adequacy was 95.4% (95% confidence interval [CI] 93.1-97.8), while the pooled rate of diagnostic accuracy was 93.4% (95%CI 90.7-96.1). The pooled rate of adverse events with transesophageal EUS-guided TA from lung masses was 0.7% (95%CI 0.0-1.6%). There was no significant heterogeneity with respect to various outcomes and results were comparable on sensitivity analysis. CONCLUSIONS: EUS-FNA offers a safe and accurate diagnostic modality for the diagnosis of paraesophageal lung masses. Future studies are needed to determine the needle type and techniques for improving outcomes.