Transesophageal endoscopic ultrasound in the diagnosis of the lung masses: a multicenter experience with fine-needle aspiration and fine-needle biopsy needles

background and aim Intraparenchymal lung masses inaccessible through bronchoscopy or endobronchial ultrasound guidance pose a diagnostic challenge. furthermore, some fragile or hypoxic patients may be poor candidates for transbronchial approaches. endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) offers a potential diagnostic approach to lung cancers adjacent to the esophagus. we aimed to evaluate the feasibility, accuracy, and safety of trans-esophageal EUS-FNA/FNB for tissue sampling of pulmonary nodules. methods we retrospectively analyzed data from patients with pulmonary lesions who underwent EUS-FNA/FNB between march 2015 and august 2021 at eight Italian endoscopic referral centers. Results A total of 47 patients (36 male; mean age 64.47 +/- 9.05 years) were included (22 EUS-FNAs and 25 EUS-FNBs). overall diagnostic accuracy rate was 88.9% (76.3-96.2%). the sensitivity and diagnostic accuracy were superior for EUS FNB sampling versus EUS-FNA (100% vs. 78.73%); P = 0.05, and (100% vs. 78.57%); P = 0.05, respectively. additionally, sample adequacy was superior for EUS-FNB sampling versus EUS-FNA (100% vs. 78.5%); P = 0.05. multivariate logistic regression analysis for diagnostic accuracy showed nodule size at the cutoff of 15 mm (OR 2.29, 1.04-5.5, P = 0.05) and use of FNB needle (OR 4.33, 1.05-6.31, P = 0.05) as significant predictors of higher diagnostic accuracy. there were no procedure-related adverse events. conclusion this study highlights the efficacy and safety of EUS-FNA/FNB as a minimally invasive procedure for diagnosing and staging peri-esophageal parenchymal lung lesions. the diagnostic yield of EUS-FNB was superior to EUS-FNA.