Endobronchial Ultrasound (EBUS): A Minimally Invasive Approach for Lung Diagnosis

An Endobronchial ultrasound (EBUS) allows your doctor to see the airways that lead to your bronchi. Additionally, it might assist your doctor with a treatment like a biopsy.

You won’t need to have any surgical cuts made to your chest for an EBUS because a bronchoscope is used to perform this task. However, if your doctor suspects you have a lung ailment such as an infection, lung cancer, lymphoma, or an inflammatory illness like sarcoidosis, they may order an EBUS.

Lung cancer can be diagnosed or its stage determined using endobronchial ultrasound (EBUS), a medical procedure carried out during a bronchoscopy. During an EBUS, a flexible scope is passed through the mouth into the main bronchi of the lungs to examine tissues using high-frequency sound waves.

Endobronchial ultrasonography is risk-free and minimally invasive, requiring neither surgery nor ionising radiation exposure. It can also aid in diagnosing some inflammatory lung disorders that cannot be validated by conventional imaging testing. It is often done as an outpatient procedure.

What Can EBUS Diagnose?

In the case of Mediastinal lesions (masses and nodes), symptoms are non-specific and vague. They may even be completely asymptomatic (nearly 40-60%) and identified on incidental imaging (e.g., a chest CT as part of a master health check-up/ insurance/ job fitness). But if a person has symptoms such as cough with or without sputum production, breathing difficulty, chest pain, blood in sputum, difficulty in swallowing, recent change in voice, loss of weight and appetite, chest discomfort, wheezing, and noisy breathing, they often point towards some underlying disease. In an era of precision and personalised medicine where “tissue is the issue,” a confirmatory diagnosis of the varied aetiology with utmost accuracy is possible with EBUS; thereby, it helps to overcome the diagnostic dilemma leading to undue delay in appropriate treatment as well as unwarranted treatment.

EBUS is not only known for its accuracy but also for its safety. It is extremely safe (99.3%) with minimal complications such as minor bleeding, cough, fever and in rare cases mediastinitis. Recently, Pulmonologists, especially in the last decade, have started to use the EBUS Scope in the esophagus and procure samples from the mediastinum, a technique popularly referred to as “EUS-B-FNA” in the field of Pulmonology. It is of use especially in high-risk pulmonary patients who may not tolerate a bronchoscopy and is associated with minimal complications.

Purpose of the Procedure

Endobronchial ultrasonography may be prescribed in addition to conventional bronchoscopy if you have been diagnosed with lung cancer or if your initial tests strongly suggest that you may have it.

Contrary to bronchoscopy, which uses a viewing scope to observe the airways directly, EBUS uses refracted sound waves to allow medical professionals to look through the airways’ tissues.

Endobronchial ultrasound can help determine how far a tumour has invaded the central airways. This is especially useful in cases such as metastatic lung adenocarcinomas and squamous cell carcinomas, which often begin in the airways, spread from the lung’s outer regions, and invade the central lung.

The following are the two main EBUS indications:

• Staging of Lung cancer: To ensure that the right treatment is given, lung cancer staging is used to assess the severity of the disease. Endobronchial ultrasonography, combined with a transbronchial needle aspiration (TBNA) procedure, allows doctors to collect tissue from the lung or mediastinal lymph nodes in the chest. The sampled cells are then sent to the laboratory for analysis to determine how early or advanced the cancer is.
• Evaluation of abnormal lesions: If a chest X-ray or computed tomography (CT) scan reveals an abnormal lesion, EBUS with TBNA can be utilised to collect a sample of the afflicted tissues. This can assist in determining whether cancer or an inflammatory lung disease like sarcoidosis is to blame for swollen lymph nodes. In addition, pulmonary lymphoma, a type of blood cancer, can be suspected in persons with lymph nodes that can be sampled using EBUS.

Typically, a doctor won’t use endobronchial ultrasonography as their initial method of lung cancer diagnosis. However, it is often requested when preliminary lab and imaging testing reveal the condition’s presence. With EBUS, your healthcare professional can access a mass or nodule close to a significant airway without cutting through the chest wall.

The Pulmonary Medicine Department has completed 100 EBUS (Endobronchial Ultrasound) procedures, showcasing its growing expertise in this advanced diagnostic technique.

Before the Procedure

Endobronchial ultrasonography, like bronchoscopy, is generally considered safe with a low risk of complications. Preparing is easier when you know what to expect.

Timing

Even though the EBUS technique only takes 20 to 30 minutes to complete, getting ready for the surgery and recovering from the anaesthetic can take up to four hours. Therefore, it is recommended to cancel all of your appointments on the day of your treatment and plan a second day off so you can recover.

What to Wear

Dress comfortably with items of clothing that are simple to take off and put back on because you will be required to change into a hospital gown. Leave any jewellery or valuables at home if at all possible.

Before the operation, be ready to take off any dentures, hearing aids, contacts, or eyeglasses. You’ll be provided with a safe location to store items in addition to your wardrobe and other possessions.

Food and Beverage

You’ll typically be instructed to stop eating at midnight the day before the surgery. Most EBUS procedures are scheduled for the morning to prevent you from being overly hungry. The healthcare professional could urge you to cease eating six hours before the procedure if it is planned for later in the day.

During the EBUS Procedure

The bronchoscope is a tiny, illuminated tube inserted by your doctor into your mouth, down your windpipe, and into the bronchi. Your doctor can view your airways, blood vessels, lungs, and lymph nodes on an ultrasound monitor thanks to a tiny camera attached to the bronchoscope.

To collect tissue and fluid samples from your lungs and nearby lymph nodes, your doctor can use the bronchoscope, which also contains a fine needle. Transbronchial needle aspiration is the procedure’s name, and biopsy is the name of the sample.

Following EBUS, after the surgery, you won’t be able to cough for a few hours. For a few days, your throat could feel sore and scratchy.

After the Procedure

Your doctor will forward the biopsy sample to a lab, where it will be examined. Your doctor can determine the stage of your lung cancer using the information from the needle aspiration.

Your doctor will explain the results to you and outline any follow-up actions.

Risks

While EBUS bronchoscopy is considered a safe and minimally invasive procedure, some risks still exist. Minor complications may include slight bleeding or a sore throat after the test. In rare cases, more serious issues like lung collapse, chest infections, or breathing difficulties can occur. Some patients may also need additional oxygen or a short hospital stay if complications arise. Always inform your doctor of any prior reactions to sedation or anesthesia. If you become unwell after the procedure with signs like chest discomfort, a high temperature, or trouble breathing, get medical help immediately.

What is the EBUS-TBNA Test?

EBUS-TBNA is a day care procedure, and it takes approximately 30-60 minutes, depending on the indication. Even if we were to include the recovery and observation time it does not usually take more than 4 hours, unlike major surgeries or other complicated procedures, the patient may not be subjected to general anaesthesia but can be performed under ‘conscious sedation’ (a term used by the British Society of Anaesthesiologists refers to a sedation where verbal contact with patient is possible throughout the procedure) making a sophisticated procedure simplified for both patients and the bronchoscopist.

Besides, there are only a few and far-fetched centres with this expertise in our city and only a handful in the entire state with a fully functional set-up, including ours, thereby enabling us to unlock the door to lung and mediastinum lesions which were treated empirically since time immemorial and even in this modern age without any obvious cytological or histopathological confirmation. Yet, there seems to be an appalling paucity of awareness about EBUS among our patients and physicians alike as well as the general public. I conclude this message with a small quote, “Knowledge is Wealth” & We at the Department of Pulmonary Medicine, Rela multispeciality hospital have the luxury of EBUS with us and I have put an earnest effort to provide a glimpse of this modality through my letter, which has changed the landscape of Interventional Pulmonology across the Globe, something akin to coronary angiogram (CAG) in Cardiology.

Results

Following the EBUS procedure, the gathered samples are analysed in a lab to detect signs of infection, inflammation, or cancer. Results are typically ready within a few days to a week. Your doctor will go over the results with you and discuss any follow-up steps, which could include more testing or starting treatment. If severe conditions are detected, a care plan will be created with the help of specialists. While waiting, don’t hesitate to reach out to your healthcare team or a trusted person for support.

Frequently Asked Questions