ERS/ESGE/ESTS clinical practice guidelines on endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

BACKGROUND: the major airways (EBUS-TBNA) and oesophagus (EUS-FNA). EUS-FNA can also be performed using an EBUS-scope (EUS-B-FNA). METHODS: Task force members were selected from ERS (European Respiratory Society), ESGE (European Society of Gastrointestinal Endoscopy), and ESTS (European Society of Thoracic Surgeons). Twelve guideline questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (final searches: Apr-2025). GRADE methodology was applied for assessing the certainty of evidence and developing recommendations. RESULTS: In (suspected) non-small cell lung cancer (NSCLC), 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 re-staging 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 high suitability rate for PD-L1 assessment. CONCLUSIONS: Endobronchial and oesophageal endosonography provide accurate and minimally invasive tests for the diagnosis and staging of lung cancer.

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Journal
European Respiratory Journal
Published
2026-05-21
DOI
https://doi.org/10.1183/13993003.00097-2026
Primary Topic
Lung Cancer Diagnosis and Treatment
Type
article
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article

ERS/ESGE/ESTS clinical practice guidelines on endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

Thomy Tonia, Evangelia Koukaki, Nicole Ngai Yung Tsang, Nerissa P. Denswil et al.
European Respiratory Journal
Lung Cancer Diagnosis and Treatment
article

ERS/ESGE/ESTS clinical practice guidelines on endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

Thomy Tonia, Evangelia Koukaki, Nicole Ngai Yung Tsang, Nerissa P. Denswil, Maciej Gnass, Efthymia Papadopoulou, Konstantina Kontogianni, Mărioara Șimon, Céline Demonceau, D Gompelmann, Andrada Seicean, Jouke T. Annema, Mateja Marc‐Malovrh, Bojan Kovacevic, Frank J C van den Broek, José Sanz-Santos, Daniël A. Korevaar, Peter Vilmann, Lars Konge, Antonio Moretti, Felix J.F. Herth, Antonio Facciorusso, Maria Joana Catarata, Nuria M. Novoa, Luca Bertolaccini
article en

Abstract

BACKGROUND: the major airways (EBUS-TBNA) and oesophagus (EUS-FNA). EUS-FNA can also be performed using an EBUS-scope (EUS-B-FNA). METHODS: Task force members were selected from ERS (European Respiratory Society), ESGE (European Society of Gastrointestinal Endoscopy), and ESTS (European Society of Thoracic Surgeons). Twelve guideline questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (final searches: Apr-2025). GRADE methodology was applied for assessing the certainty of evidence and developing recommendations. RESULTS: In (suspected) non-small cell lung cancer (NSCLC), 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 re-staging 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 high suitability rate for PD-L1 assessment. CONCLUSIONS: Endobronchial and oesophageal endosonography provide accurate and minimally invasive tests for the diagnosis and staging of lung cancer.

European Respiratory Journal
University of Bern (CH), University of Modena and Reggio Emilia (IT), University of Salento (IT), Radboud University Nijmegen (NL), University of Ljubljana (SI), University of Liège (BE), University of Milan (IT), Iuliu Hațieganu University of Medicine and Pharmacy (RO), Heidelberg University (DE), Clinical Emergency Hospital Bucharest (RO), University Hospital Heidelberg (DE), Copenhagen University Hospital (DK), Gentofte Hospital (DK), Comprehensive Cancer Center Vienna (AT), Copenhagen Academy for Medical Education and Simulation (DK), John Paul II Hospital (PL), Hospital Universitario Puerta de Hierro Majadahonda (ES), Amsterdam Neuroscience (NL), University Clinic of Pulmonary and Allergic Diseases Golnik (SI), Máxima Medisch Centrum (NL), German Center for Lung Research (DE), Mútua Terrassa (ES), Institute of Social and Preventive Medicine (CH), Hospital Braga (PT), Capital Region of Denmark (DK), Metropolitan University (BD), Amsterdam University Medical Centers (NL), G. Papanikolaou General Hospital (GR), Clinical Academic Center of Braga (PT), Sotiria General Hospital (GR), European Institute of Oncology (IT), Medical University of Vienna (AT), Vrije Universiteit Amsterdam (NL), University of Amsterdam (NL), University of Hong Kong (HK)
Partnerships for the goals
Openalex Percentile: Top 7%
Lung Cancer Diagnosis and Treatment
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