Role of EUS and Mediastinoscopy

Endobronchial ultrasound (EBUS) does not operate in isolation, and its diagnostic and therapeutic potential is often complemented by endoscopic ultrasound (EUS) and mediastinoscopy. This chapter investigates the synergistic role of these modalities, providing a comprehensive understanding of their indications, comparative strengths, and integration in clinical practice. The chapter also gives insight of procedural techniques, including linear EUS and EBUS scopes, and their complementary roles in sampling mediastinal lymph nodes and masses. The chapter also explore the role of mediastinoscopy in mediastinal lymph node biopsy.The mediastinal nodes can be evaluated by both invasive and non-invasive modes. The non-invasive mode of evaluation of mediastinal node can help identify and to certain extent determine the pathology. Since non-invasive mode is not associated with tissue diagnosis it is considered to be inferior compared to invasive mode. The non-invasive mode which are done for evaluation of mediastinal lymph nodes are contrast enhanced computed tomography of thorax (CECT thorax) and positron emission tomography (PET) scan. The invasive mode involves the use of a bronchoscopy. Flexible bronchoscopy can be used to get transbronchial needle aspiration material (TBNA) from enlarged subcarinal node, paratracheal and lower hilar nodes. With the advent of endobronchial ultrasound needle aspiration from other mediastinal nodes became feasible.