From the Guidelines
Endobronchial ultrasound (EBUS) is recommended as the initial procedure for mediastinal nodal staging in patients with suspected or proven non-small cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET) 1.
Key Points
- EBUS combines bronchoscopy with ultrasound technology to visualize and sample lymph nodes and masses adjacent to the airways.
- The procedure is minimally invasive and allows for precise needle aspiration of suspicious lymph nodes or masses for diagnostic purposes.
- EBUS is particularly valuable for accessing mediastinal and hilar lymph nodes without requiring more invasive surgical procedures like mediastinoscopy.
- Patients typically receive moderate sedation or general anesthesia, and the procedure usually takes 30-60 minutes.
- Recovery is relatively quick, with most patients discharged the same day.
- EBUS has significantly improved lung cancer staging accuracy while reducing complications compared to more invasive alternatives, making it the preferred initial approach for mediastinal lymph node evaluation in many clinical scenarios.
Recommendations
- For mediastinal nodal staging in patients with suspected or proven NSCLC, EBUS is recommended over surgical staging as the initial procedure 1.
- The combination of EBUS and endoscopic (oesophageal) ultrasound with fine needle aspiration (EUS-FNA) is preferred over either test alone 1.
- If the combination of EBUS and EUS-(B) is not available, EBUS alone is acceptable 1.
- Subsequent surgical staging is recommended when endosonography does not show malignant nodal involvement 1.
From the Research
EBUS Overview
- Endobronchial ultrasound (EBUS) is a minimally invasive procedure used for diagnosing and staging lung cancer, particularly for mediastinal lymph node staging 2, 3, 4.
- EBUS-transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic yield and accuracy for detecting malignancy and lung cancer 2, 4.
Diagnostic Yield and Accuracy
- The diagnostic yield of EBUS-TBNA is around 66% 2, with a diagnostic accuracy of 98.0% for detecting malignancy and 98.5% for lung cancer 2.
- The sensitivity, specificity, positive, and negative predictive values for lung cancer stage ≥N1 and malignant disease are high, with some studies reporting 100% sensitivity and specificity 2.
Comparison with Other Diagnostic Methods
- EBUS-TBNA is considered a complementary method to mediastinoscopy, rather than a substitute, due to its minimally invasive nature and high diagnostic yield 2, 5.
- EBUS-TBNA has been compared to other diagnostic methods, such as CT scan and PET scan, and has been found to be a valuable tool in the diagnosis and staging of lung cancer 3, 5.
Clinical Applications
- EBUS-TBNA is useful in the diagnosis of mediastinal and hilar lymph node pathology, and is considered an essential endoscopic technique in the staging of lung cancer 3, 4.
- EBUS-TBNA can also be used to diagnose lymphoma, with a high sensitivity and low false-negative rate when specimens are adequate for analysis 6.