TY - JOUR
T1 - ERS/ESGE/ESTS clinical practice guidelines on endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer
AU - Korevaar, Daniël A.
AU - Kovacevic, Bojan
AU - Papadopoulou, Efthymia
AU - van den Broek, Frank J.C.
AU - Bertolaccini, Luca
AU - Catarata, Maria Joana
AU - Denswil, Nerissa P.
AU - Facciorusso, Antonio
AU - Gnass, Maciej
AU - Gompelmann, Daniela
AU - Herth, Felix J.F.
AU - Kontogianni, Konstantina
AU - Koukaki, Evangelia
AU - Marc-Malovrh, Mateja
AU - Simon, Marioara
AU - Moretti, Antonio
AU - Novoa, Nuria M.
AU - Seicean, Andrada
AU - Tsang, Nicole Ngai Yung
AU - Demonceau, Céline
AU - Tonia, Thomy
AU - Sanz-Santos, José
AU - Konge, Lars
AU - Vilmann, Peter
AU - Annema, Jouke T.
N1 - Publisher Copyright:
Copyright ©The authors 2026. For reproduction rights and permissions contact [email protected].
PY - 2026/8/1
Y1 - 2026/8/1
N2 - BACKGROUND: In lung cancer, adequate treatment selection relies on accurate diagnosis and staging. Tissue sampling is generally indicated. This guideline explores the role of endosonography via the major airways (endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)) and oesophagus (endoscopic transoesophageal ultrasound-guided fine-needle aspiration (EUS-FNA)). EUS-FNA can also be performed using an EBUS scope (EUS-B-FNA). METHODS: Task force members were selected from the European Respiratory Society, European Society of Gastrointestinal Endoscopy and European Society of Thoracic Surgeons. Members formulated 12 guideline questions. Systematic literature searches were performed in MEDLINE and Embase (final searches: April 2025). Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied for assessing the certainty of evidence and developing recommendations. RESULTS: In (suspected) non-small cell lung cancer, endosonography is recommended over mediastinoscopy for mediastinal nodal tissue staging. Systematic staging is suggested over targeted staging as the minimal standard. Ideally, combined EBUS-TBNA+EUS(-B)-FNA is performed instead of EBUS-TBNA alone. Add-on mediastinoscopy after a negative endosonography is not recommended. Endosonography is suggested over mediastinoscopy for restaging after induction therapy. EBUS-TBNA and EUS(-B)-FNA are recommended for centrally located tumours adjacent to the major airways/oesophagus. Both EUS-B-FNA and EUS-FNA are suggested for left adrenal gland analysis. It is suggested that competence is acquired in a simulation-based environment and ensured using valid assessment methods. 21G/22G TBNA needles are considered the standard; there is insufficient evidence to support the structural use of alternative needle sizes/types or cryobiopsy. EBUS-TBNA has a high suitability rate for programmed death-ligand 1 assessment. CONCLUSIONS: Endobronchial and oesophageal endosonography provide accurate and minimally invasive tests for the diagnosis and staging of lung cancer.
AB - BACKGROUND: In lung cancer, adequate treatment selection relies on accurate diagnosis and staging. Tissue sampling is generally indicated. This guideline explores the role of endosonography via the major airways (endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)) and oesophagus (endoscopic transoesophageal ultrasound-guided fine-needle aspiration (EUS-FNA)). EUS-FNA can also be performed using an EBUS scope (EUS-B-FNA). METHODS: Task force members were selected from the European Respiratory Society, European Society of Gastrointestinal Endoscopy and European Society of Thoracic Surgeons. Members formulated 12 guideline questions. Systematic literature searches were performed in MEDLINE and Embase (final searches: April 2025). Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied for assessing the certainty of evidence and developing recommendations. RESULTS: In (suspected) non-small cell lung cancer, endosonography is recommended over mediastinoscopy for mediastinal nodal tissue staging. Systematic staging is suggested over targeted staging as the minimal standard. Ideally, combined EBUS-TBNA+EUS(-B)-FNA is performed instead of EBUS-TBNA alone. Add-on mediastinoscopy after a negative endosonography is not recommended. Endosonography is suggested over mediastinoscopy for restaging after induction therapy. EBUS-TBNA and EUS(-B)-FNA are recommended for centrally located tumours adjacent to the major airways/oesophagus. Both EUS-B-FNA and EUS-FNA are suggested for left adrenal gland analysis. It is suggested that competence is acquired in a simulation-based environment and ensured using valid assessment methods. 21G/22G TBNA needles are considered the standard; there is insufficient evidence to support the structural use of alternative needle sizes/types or cryobiopsy. EBUS-TBNA has a high suitability rate for programmed death-ligand 1 assessment. CONCLUSIONS: Endobronchial and oesophageal endosonography provide accurate and minimally invasive tests for the diagnosis and staging of lung cancer.
UR - https://www.scopus.com/pages/publications/105046753669
U2 - 10.1183/13993003.00097-2026
DO - 10.1183/13993003.00097-2026
M3 - Journal article
C2 - 42167778
AN - SCOPUS:105046753669
SN - 0903-1936
VL - 68
JO - The European respiratory journal
JF - The European respiratory journal
IS - 2
ER -