Linear endobronchial ultrasonography: a novelty turned necessity for mediastinal nodal assessment

Abstract

Linear endobronchial ultrasound was first described in 2003. Since then the technique has spread rapidly and has now become an established practice in many centres as the first-line mediastinal investigation for the diagnosis and staging of lung cancer. In combination with endoscopic ultrasound, the majority of the mediastinum can be assessed and this approach has been shown to have equivalent accuracy to surgical staging. This strategy is also cost-effective. New tissue processing techniques using liquid-based thin-layer cytology and cell blocks have increased diagnostic yield using immunohistochemical staining and molecular diagnostics. Several meta-analyses of case series and, more recently, randomised controlled trials have provided high-level evidence of efficacy leading to incorporation into national lung cancer staging guidelines. In addition, linear endobronchial ultrasound is increasingly used in the investigation of mediastinal lymphadenopathy for suspected sarcoidosis, tuberculosis and lymphoma. While undoubtedly endobronchial/endoscopic ultrasound has reduced the need for surgical staging in lung cancer, the latter still has an important role to play in certain scenarios. The challenge now facing clinicians is to learn to apply the appropriate test or sequence of tests in each patient while ensuring that operators are appropriately trained in order to ensure optimal outcomes.

The real value of endobronchial ultrasound

“…[1] In combination with endoscopic ultrasound the major part of the mediastinum can be assessed; this approach has been shown to be as accurate as surgical staging. [1] This strategy is also cost-effective.…”

“…[1] In combination with endoscopic ultrasound the major part of the mediastinum can be assessed; this approach has been shown to be as accurate as surgical staging. [1] This strategy is also cost-effective. [1] EBUS-TBNA has been demonstrated to be a safe [2] and valuable diagnostic tool in lung cancer, [3] sarcoidosis, [4] tuberculosis [5] and lymphoma.…”

“…[1] This strategy is also cost-effective. [1] EBUS-TBNA has been demonstrated to be a safe [2] and valuable diagnostic tool in lung cancer, [3] sarcoidosis, [4] tuberculosis [5] and lymphoma. [6] In our patient, the value of EBUS was threefold: (i) the technique is minimally invasive and safe compared with a surgical procedure; (ii) it was used to localise the lesion not abutting the bronchial wall and the proximity of major vessels, precluding conventional bronchoscopy; and (iii) the longer EBUS needle was used owing to the depth of the lesion.…”

Utilidad del ultrasonido endobronquial para el diagnóstico y etapificación del cáncer pulmonar

“…Este método se comenzó a utilizar a principios del año 2000 por Herth y cols, y desde entonces se ha utilizado progresivamente para guiar la aspiración transbronquial (TBNA), acumulándose en la actualidad una importante experiencia de más de 10 años 4,6,7 . El EBUS lineal es un broncoscopio específico, donde en su extremo distal posee un transductor de ultrasonido, con emisión de frecuencias de onda entre 5 a 7.5 MHz con mayor penetración a los tejidos subyacentes aunque con menor poder de definición, permitiendo un campo visual de 50 a 90 grados (Figura 1).…”

Conventional bronchoscopic techniques in sarcoidosis: not too far behind

“…We read with interest the review by Rintoul et al 1 wherein the authors have summarised the usefulness of linear endobronchial ultrasound (EBUS) in a lucid manner. In the section on ‘Investigation of Suspected Sarcoidosis’, the authors state that the diagnostic yield to detect granulomas using endosonography (80%) is significantly higher than bronchoscopy (53%) using transbronchial lung biopsy (TBB) and endobronchial biopsy (EBB) as demonstrated by the GRANULOMA trial 2.…”