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Uses and Purpose of Endobronchial Ultrasound

Endobronchial ultrasound (EBUS) is a minimally invasive procedure used for diagnosing lung cancer and certain inflammatory lung diseases that cannot be confirmed with standard imaging tests. The procedure can also help determine the stage of lung cancer.

EBUS is a flexible scope that is inserted through the mouth and into the larger airways of the lungs to image tissues using high-frequency sound waves. The procedure is typically performed on an outpatient basis.

The Two Primary Indications for EBUS

1. Staging of lung cancer: Staging is used to determine the severity of lung cancer so that the appropriate treatment is delivered. EBUS allows healthcare providers to obtain tissue from within the lung or mediastinal lymph nodes in the chest using a technique called transbronchial needle aspiration (TBNA). The biopsied cells can then be sent to the lab for analysis to help determine how early or advanced the cancer may be.
2. Evaluation of abnormal lesions: If an abnormal lesion is found on a chest X-ray or computed tomography (CT) scan, EBUS with TBNA can be used to obtain a sample of the affected tissues. Doing so can help confirm if swollen lymph nodes are caused by cancer or an inflammatory lung disease like sarcoidosis.

Limitations of Endobronchial Ultrasound

While EBUS is a useful diagnostic tool, there are limitations to its use. The technique is only able to image a limited amount of lung tissue, and may not be able to detect metastasis to other parts of the mediastinum.

Similar Tests to Endobronchial Ultrasound

Prior to the introduction of endobronchial ultrasonography, the accurate staging of lung cancer required invasive procedures that accessed the lungs via the thorax. These include:

• Mediastinoscopy: A scope is inserted through an incision at the top of the sternum (breastbone)
• Thoracoscopy: Small incisions are made between the ribs of the chest to access the lungs using narrow, specialized tools and a viewing scope
• Thoracotomy: An open lung surgery

Endobronchial ultrasound provides healthcare providers with the necessary information without the risks associated with surgery.

Preparing for the Procedure

Prior to the procedure, patients will need to complete a consent form and disclose any medications they are taking, as well as any allergies they have or adverse reactions they have experienced. A consent form will be used to discuss the potential benefits and risks of the procedure, as well as provide information about anesthesia.

Patients will also be given guidance on what to expect following the procedure, including sore throat, hoarseness, and coughing. It is also common for patients to experience pinkish or reddish phlegm if a biopsy is performed, which is generally not a cause for concern.

The Procedure

Endobronchial ultrasound is typically performed under procedural anesthesia, meaning patients will experience a “twilight sleep” but will not sleep as deeply as they would with a general anesthetic.

Prior to the procedure, patients may be given oxygen through an IV line and an anesthesia mask. A small dose of anesthesia may be injected through the IV line or an anesthesia mask.

Patients will be monitored closely by a healthcare team throughout the procedure, and the nurse will insert an IV line into a vein in their arm to administer oxygen, antibiotics, and other medications as necessary.

Interpreting Results

Following the procedure, patients will receive test results, which will outline any abnormalities found in their lung tissue. The report may include:

• The type of cancer (lung adenocarcinoma, squamous cell carcinoma, large cell carcinoma, etc.)
• The histological findings: cellular characteristics seen under the microscope
• The molecular test results: a report of the genetic profile of their cancer

These pieces of information can be used to determine the stage and grade of the disease, as well as ensure appropriate treatment.

Conclusion

Endobronchial ultrasound (EBUS) is a minimally invasive procedure that is used to diagnose lung cancer and certain inflammatory lung diseases. The procedure has been shown to be more accurate than traditional methods in diagnosing lung cancer.

FAQs

Q: How does the procedure work?

The procedure involves inserting a flexible tube into the airways of the lungs to take images of the tissue. A needle can be passed through the tube to obtain biopsy samples.

Q: How long does the procedure take?

The procedure typically takes around 1-2 hours, with the actual ultrasound imaging and biopsy taking around 1-2 minutes per segment.

Q: Can I drive home after the procedure?

Patients may experience dizziness, headaches, and nausea following the procedure, so it is recommended that they do not drive home and instead be driven by a responsible party.

Q: When can I return to my normal activities?

Most patients are able to resume their normal activities within a few days of the procedure, but may need to take it easy for several weeks.