A REVIEW OF ENDOBRONCHIAL ULTRASOUND GUIDED TRANSBRONCHIAL NEEDLE ASPIRATE (EBUS-TBNA)

EBUS-TBNA

Abstract

INTRODUCTION

Fine-needle aspiration cytology (FNAC) is a method used since long along with different stereotactic guidance. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a sampling method for patients who have enlarged mediastinal or hilar lymph nodes/masses, detected on computed tomography^1-3. Endobronchial ultrasound (EBUS) uses ultrasound along with bronchoscope to visualize airway wall and structures adjacent to it. The clinical application and diagnostic benefits of EBUS have been recognized and EBUS has been assimilated into routine practice in many centers because of its high diagnostic informative value and low risk. In future it is most likely to replace the invasive methods for evaluating mediastinal lymphadenopathy, other lesions and also for  staging lung cancer^4-5. Other techniques are available for suspected lesions of the mediastinum, including standard flexible bronchoscopy with blind TBNA, transthoracic needle aspiration, mediastinoscopy etc but EBUS-TBNA is least invasive, and has good diagnostic yield for meditational pathologies⁷. Hilar nodal stations are difficult to access and may require thoracoscopy and on occasion a thoracotomy. Moreover, these techniques  cannot be repeatedly applied on the same patient^8,9. Contrary to this, EBUS-TBNA, when combined with EUS (Endoscopic Ultrasound Guided), can sample all the key nodal stations and also can be performed repetitively^6,10,11.  The start of EBUS-TBNA dates back to early 1990s^6,12. At present throughout Pakistan, EBUS-TBNA is being carried out only in a couple of centers (pulmonology department, military hospital being one of them), hence limited local data and information is available regarding this procedure. The technology is available in two forms: radial EBUS and linear EBUS-TBNA probes.