Abstract Background Esophageal cancer management necessitates an ability to accurately assess the presence and degree of tracheal invasion by an encroaching tumor. While endoscopic ultrasound (EUS) is regarded as the gold standard for locoregional staging, its diagnostic accuracy can be limited by esophageal stenosis or when tumors are adjacent to the airway. The role of linear endobronchial ultrasound (EBUS) in this setting has been described in the literature but is not currently included in guideline recommendations. This case highlights linear EBUS as a tool for assessing tracheobronchial wall invasion and confirming nodal involvement as a comparable diagnostic tool when EUS is limited. Case A 70-year-old male, former 40 pack-year smoker, presented with four months of progressive dysphagia and reflux. Esophagramdemonstrated a 3.2 cm irregular mid-esophageal stricture, and EGD revealed a large, circumferential fungating mass 33 cm from the incisors with high-grade dysplasia and carcinoma in situ. PET-CT showed intense FDG avidity the distal esophagus with hypermetabolic mediastinal and paratracheal lymph nodes, but no extra thoracic disease, consistent with locally advanced esophageal SCC. Bronchoscopy revealed mucosal irregularity and nodularity along the right main carina concerning for airway invasion. EBUS-guided transbronchial needle aspiration of stations 3P (retro tracheal) lymph nodes demonstrated malignant squamous cells, indicatingT3N1M0 staging. The patient received four cycles of induction FOLFOX/Nivolumab for cytoreduction. Repeat bronchoscopy and EBUS after three months confirmed persistent distal tracheal and right main bronchial invasion. The patient was deemed a poor surgical candidate and subsequently underwent definitive chemoradiation with weekly carboplatin and paclitaxel administered concurrently with 28 fractions of targeted esophageal radiation over 8 weeks. He completed therapy and awaited follow-up imaging to assess treatment response. Discussion While EUS remains the standard for T and N staging, its accuracy decreases in the presence of strictures. In scenarios where EUS is technically limited, EBUS can be an adjunct tool for staging. Linear EBUS utilizes a high-frequency transducer (7.5-20 MHz) to achieve tracheobronchial wall layer differentiation. EBUS is minimally invasive and can identify adventitial disruption, and provide cytologic confirmation of nodal involvement. Radial EBUS, which produces planar 360° images, has been used to assess airway integrity in the past, but its utility in the large airways is limited by a lack of continuous circumferential contact and acoustic coupling, thus limiting its utility for assessing esophageal tumors.. This report emphasizes the role of linear EBUS as a complementary tool in managing complex esophageal squamous cell carcinoma. This abstract is funded by: None
Ruiz et al. (Fri,) studied this question.