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Vol. 59. Issue 10.
Pages 675 (October 2023)
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Vol. 59. Issue 10.
Pages 675 (October 2023)
Clinical Image
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Fanning Technique for Endobronchial Ultrasound-Guided Transbronchial Mediastinal Cryobiopsy: It is Possible
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Miguel Angel Ariza-Protaa,
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arizamiguel@hotmail.com

Corresponding author.
, Javier Pérez-Pallarésb, Francisco López-Gonzáleza
a Pulmonologist, Hospital Universitario Central de Asturias (HUCA), Pulmonology Department, Oviedo, Spain
b Pulmonologist, Hospital Universitario Santa Lucía, Pulmonology Department, Cartagena, Murcia, Spain
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EBUS-TBNA sampling techniques vary greatly among interventional pulmonologists. One of those variations is the fanning technique, which consists of sampling multiple areas within a lymph node in each pass by using the “up–down” lever of the EBUS scope. Fanning technique is especially used in endoscopic ultrasound-fine needle aspiration for pancreatic lesions1. It could be argued that one of the drawbacks of performing an EBUS-guided mediastinal cryobiopsy (Cryo-EBUS) is that it is limited to taking a sample from a single area of the lesion since the 1.1mm cryo-probe (Erbecryo 20402-401, Tubingen, Germany) is inserted through a single pathway created by the FNA puncture. We show the case of a 52-year-old man with an enlarged subcarinal lymph node (station 7) localized by EBUS and a fine needle aspiration (FNA) was performed using a 22-G needle (SonoTip TopGain; Medi-Globe, Rohrdorf, Germany). After the FNA was performed, the 1.1mm cryoprobe was introduced gently under ultrasound guidance through the single pathway created by the FNA puncture; once inside the lymph node we performed the fanning technique, positioning the cryo-probe in the desired area by moving the lever of the EBUS scope up or down (Fig. 1). Three cryobiopsies were taken in three different areas of the lymph node by freezing for 5s with no complications. The diagnosis was compatible with small cell lung carcinoma.

Fig. 1.

EBUS image showing the 1.1mm cryo-probe inside the station 7 lymph node. By performing the fanning technique, we were able to accurately place the cryo-probe in multiple zones of the lymph node.

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Conflict of interests

The authors state that they have no conflict of interests.

Appendix A
Supplementary material

Supplementary material associated with this article can be found in the online version available at doi:10.1016/j.arbres.2023.08.004

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Reference
[1]
J.M. Lee, H.S. Lee, J.J. Hyun, J.M. Lee, I.K. Yoo, S.H. Kim, et al.
Slow-pull using a fanning technique is more useful than the standard suction technique in EUS-guided fine needle aspiration in pancreatic masses.
Gut Liver, 12 (2018), pp. 360-366
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