Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities

Abstract

Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound–TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.

Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer

“…Both can be performed as same-day procedures following bronchoscopy and EBUS. EUS-B is attractive to pulmonologists and administrators since it requires little additional training and no additional equipment when running an EBUS service, and the number of scientific reports on EUS-B is growing [ 9 , 10 ]. The aim of this narrative review is to summarize current evidence on utility of EUS-B-FNA in lung cancer work-up, alone or in combination with EBUS, including which structures that can be biopsied.…”

Utility of SHOX2 and RASSF1A gene methylation detection on the residual cytology material from endobronchial ultrasound-guided transbronchial needle aspiration

“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a common minimally invasive procedure that combines bronchoscopy with ultrasound to both diagnose and stage lung cancer, infections, and other conditions affecting the lungs, mediastinum or lymph nodes. [ 1 , 2 ] It offers the advantage of real-time imaging and concurrent sampling. By visualizing the specific target area with ultrasound guidance, the operator can obtain samples using a fine needle for cytology (conventional smear and liquid-based cytology [LBC]) and cell block (CB).…”

“…[ 1 ] This integrated approach minimizes the potential risks of complications and ensures a more efficient diagnostic process. [ 2 ]…”

The evolution of endobronchial ultrasound usage in modern era

“…Over the last two decades, EBUS has undergone significant evolution and has emerged as a pivotal tool in the realm of pulmonary diseases. This technique allows bronchoscopists to visualize structures beyond the airways, including the airway wall, lung, and mediastinum, facilitating sample collection ( 1 , 2 ). Guidelines recommend EBUS as the primary approach for staging the mediastinum of lung cancer ( 3 , 4 ).…”

“…The need for sufficient tissue for accurate cancer diagnosis and molecular analysis has led the bronchoscopist to modify their usual approach to ensure sample adequacy. Consequently, there has been a noticeable increase in the development of novel EBUS applications extending beyond the traditional endobronchial approach ( 1 , 1 , 1 ). This review aims to highlight the diverse applications of convex probe EBUS beyond its conventional role in diagnosing and staging lung cancer.…”