Endosonography for lung cancer staging

Endosonography is a minimally invasive and safe, but also challenging procedure that has been positioned as the first line nodal tissue staging procedure for lung cancer. In this thesis, it has been shown that the concept of one (EBUS – endobronchial ultrasound) scope, single operator, systematic endobronchial and esophageal approach to evaluate all loco-regional lymph nodes and the left adrenal gland in the same session, might qualify as the optimal way to stage lung cancer patients. A structured ERS (European Respiratory Society) training program to educate and train bronchoscopists to be able to independently and competently perform EBUS has been developed and may facilitate this objective. Despite promising developments in imaging modalities, smart needles (like optical coherence tomography and needle based confocal laser endomicroscopy) and tumor labeling, the largest improvement for accurate nodal staging will probably be achieved by adequate education and training of pulmonologists.