What is your experience with transesophageal lung mass biopsies?

Thoracic lesions requiring FNA in the mediastinum are often best approached with EUS–FNA, as the sedation and airway management are less complex than the EBUS, and the needle does not need to break through cartilage rings to access the lesion. On the other hand, a lung mass would require the needle to cross the pleura, and this should be done only on a case-by-case basis when asked by your thoracic colleagues to do so. The lesion would have to be adjacent to the mediastinum, and I would suggest using a 25-gauge needle to reduce the chance of procedure-related pneumothorax.

As Dr. @Dr. First Last points out, lung masses can be biopsied via EUS if adjacent to the esophagus, and best without intervening pleura. There was a recent article published in Gastrointestinal Endoscopy about it: Rizzo et al., PMID 39368717.

Interestingly, in this study, 80% of the needles used were 22G!