Endoscopic ultrasound guided liver biopsy in the hands of a chest physician

Background: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) with the gastrointestinal (GI) endoscope from the left adrenal gland for staging of lung cancer patients is well described as an accurate method. In recent years, chest physicians have started using an endoscope designed for endobronchial ultrasound (EBUS) in the esophagus (EUS-B) for detection and biopsy of lesions both above and below the diaphragm including the left adrenal gland. Liver biopsy using transesophageal bronchoscopic ultrasound guided fine needle aspiration (EUS-B-FNA) has never been described before and biopsies of infradiaphragmatic lesions using this technique are not considered to be standard. Patients and methods: A patient suspected for primary lung cancer with multiple lesions in the liver was referred to our department. We conducted bronchoscopy and endobronchial ultrasound guided (EBUS) biopsy from several enlarged mediastinal lymph nodes. Thereafter, we conducted EUS-B-FNA from a lesion in the left liver lobe. Results: Pathology showed that the liver lesion represented a metastasis from a pulmonary adenocarcinoma. Bronchoscopy and EBUS samples were not able to establish diagnosis. Conclusions: We have demonstrated that a diagnostic EUS-B-FNA from a liver metastasis in a patient with lung cancer is possible. This underlines that chest physicians should not forget the esophagus when staging lung cancer.