Endobronchial Ultrasound in Lung Cancer Staging

Abstract

In Brief Endobronchial ultrasound (EBUS) is a minimally invasive staging method that has emerged as a potential alternative to mediastinoscopy in lung cancer staging. The radial probe EBUS was initially developed in the 1990s and demonstrated to be a technique with a higher diagnostic yield than conventional blind transbronchial needle aspiration, with a pooled sensitivity of 78%. The new EBUS-guided fine needle aspiration (EBUS-FNA) is a real-time ultrasonographically visualized puncture that achieves a sensitivity of 92.5%, a negative predictive value of 91% and a diagnostic accuracy of 95% on average. Lymph nodes down to 5 mm can be successfully sampled and there are no reports of major complications. The combination of EBUS-FNA and transesophageal ultrasound FNA (EUS-FNA) provides complementary and near global staging of the mediastinum, covering more lymph node stations than mediastinoscopy alone. A potential lung cancer algorithm of the future would use endoscopic minimally invasive approaches and restrict diagnostic surgical procedures to negative needle cytology results. Endobronchial ultrasound with fine-needle aspiration is a real time biopsy technique that enables minimally invasive staging of lung cancer. This article describes the basic technical information, the indications, and the outcomes, and proposes a staging algorithm of the future.