EUS‐B‐FNA Enabled Pathological Diagnosis After Airway Stenting due to Severe Stenosis by Adenocarcinoma

ABSTRACT

A 49‐year‐old man with severe airway stenosis and SVC syndrome underwent urgent Y‐stent placement before diagnosis. Subsequent EUS‐B‐FNA enabled adenocarcinoma diagnosis. This case highlights that transbronchial biopsy in marked stenosis risks fatal obstruction; thus, transesophageal biopsy should be prioritised to ensure safe diagnosis and genomic testing.

After silicone Y‐stent placement, endoscopic ultrasound with bronchoscope‐guided fine‐needle aspiration (EUS‐B‐FNA) was performed.

A 49‐year‐old man presented with progressive cough and inspiratory stridor. Chest imaging revealed severe airway stenosis caused by a right upper‐lobe mass invading the mediastinal lymph nodes (LNs) (Figure 1A). Although a definitive diagnosis had not yet been established, airway stenting was required to manage the oncological emergency of critical stenosis complicated by superior vena cava syndrome. Prioritising biopsy risked aspiration and complete airway obstruction; therefore, stent placement was performed first. Even with the stenosis covered by the stent, a trans‐oesophageal biopsy route was deemed feasible (Figure 1B). Rigid bronchoscopy confirmed > 90% luminal stenosis due to extrinsic compression (Figure 1C). Placing a silicone Y‐stent immediately relieved the obstruction with remarkable clinical improvement (Figure 1D). Two days later, endoscopic ultrasound with bronchoscope‐guided fine‐needle aspiration (EUS‐B‐FNA) was performed to LN #4R using a bronchoscope (BF‐UC290, Olympus) (Figure 2A,B) establishing a diagnosis of adenocarcinoma (Figure 2C). The patient was diagnosed with cT4N3M0 (stage IIIC) and subsequently received chemoradiotherapy followed by durvalumab. Genetic mutation testing with the AmoyDx assay yielded driver mutation negative.

FIGURE 1.

Chest computed tomography (CT) and bronchoscopic findings on admission demonstrating severe airway stenosis. (A) The red circle indicates severe tracheal stenosis on CT. (B) The white arrow points at the oesophagus, and the yellow dotted line indicates the trans‐oesophageal route to the tumour. (C) Bronchoscopic image of the trachea, demonstrating severe stenosis. (D) Bronchoscopy image after stenting.

FIGURE 2.

Endoscopic ultrasound with bronchoscope‐guided fine‐needle aspiration (EUS‐B‐FNA) was performed (shown by yellow dot line) after silicone Y‐stent placement. (A) Fluoroscopy showing the placed Y‐stent and the convex bronchoscope. The blue line indicates that the bronchoscope was positioned in the oesophagus. (B) Bronchoscope image shows aspirating the target lesion by EUS‐B‐FNA. (C) Histopathological findings. Tissue obtained by EUS‐B‐FNA confirmed adenocarcinoma.

Transbronchial biopsy in the setting of critical airway stenosis may lead to fatal obstruction [1]. To avoid such events, trans‐oesophageal aspiration should be considered, as it can provide safe diagnostic confirmation and adequate samples for genomic testing [2].

Funding

The authors have nothing to report.

Consent

The authors declare that written informed consent was obtained for the publication of this manuscript and accompanying images and attest that the form used to obtain consent from the patient complies with the Journal requirements as outlined in the author guidelines.

Conflicts of Interest

The authors declare no conflicts of interest.

Arimori S., Takigawa Y., Sato K., et al., “ EUS‐B‐FNA Enabled Pathological Diagnosis After Airway Stenting due to Severe Stenosis by Adenocarcinoma,” Respirology Case Reports 14, no. 1 (2026): e70476, 10.1002/rcr2.70476.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.