Transoesophageal endoscopic ultrasound with bronchoscope: insights from an Australian Local Health District ahead of lung cancer screening.

Background: The combined use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transoesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is preferred in the diagnosis and staging of non-small cell lung cancer (NSCLC); however, there is limited utilisation of EUS-B-FNA in Australia. With a National Lung Cancer Screening program (NLCSP) commencing in 2025, additional diagnostics may be required by bronchoscopists.

Aims: We describe the endoscopic model of care offered and outcomes achieved by Respiratory Physicians experienced in EUS-B-FNA practicing in a regional Australian tertiary referral hospital.

Methods: Adult patients within the Hunter New England Local Health District (HNELDH) who underwent a diagnostic/staging EBUS-TBNA or EUS-B-FNA procedures, as recorded in a prospectively collected procedural database from 2016 to 2022, were included.

Results: 1564 patients (688 female), median age 68 years had a diagnostic or staging EBUS-TBNA and/or EUS-B-FNA (1268 EBUS-TBNA, 262 EUS-B-FNA and 34 combined). The diagnostic yield for procedures performed with an indication of suspected lung malignancy was as follows: EBUS-TBNA: 75.5%, EUS-B-FNA: 85.7%, and combined procedure: 61.1%. Three major infectious complications were observed in EUS-B-FNA (1.15%) and two in EBUS-TBNA (0.16%). These complications precede the institution's policy of pre-procedural antibiotic prophylaxis started in 2021.

Conclusion: EUS-B-FNA can be performed safely by competent EBUS-TBNA respiratory physicians provided that prospective data and complication monitoring are in place.