Endobronchial Ultrasound (EBUS): Transforming Lung Diagnostics

Endobronchial Ultrasound (EBUS) is a minimally-invasive but highly-effective procedure to diagnose lung cancer, infections and other diseases that lead to enlarged lymph nodes (glands) in the chest. The Department of Interventional Pulmonology at Max Hospitals is one of the first centres in North India to offer EBUS, we take it upon ourselves to shed some light on this novel diagnostic technology that’s helping practitioners all around the world. In this article, we take a deep dive into the finer lines of this cutting-edge procedure, highlighting its types, applications, benefits and risks, followed by some frequently asked questions. Let’s start with some basics.

What is Endobronchial Ultrasound (EBUS)?

EBUS is used to examine the airways and surrounding structures in the chest, particularly the lungs and mediastinum (the area between the lungs). The ultrasound allows the healthcare provider to visualise structures such as lymph nodes, blood vessels, and tumours in real-time, helping to guide diagnostic procedures such as biopsies or needle aspirations. Being less invasive, it is considered safer than traditional surgical methods for accessing the mediastinum, with fewer complications and a shorter recovery time for patients.

What Are the Types of Endobronchial Ultrasound?

Endobronchial Ultrasound encompasses two main types, each with its unique characteristics and applications:

1. Radial Probe EBUS (RP-EBUS)

RP-EBUS involves the use of a specialised bronchoscope with a radial ultrasound probe located at the distal end of the bronchoscope. This type of EBUS provides a 360-degree view of the airway walls and surrounding structures, allowing for detailed imaging and evaluation. RP-EBUS is particularly useful for assessing peripheral lung lesions, detecting abnormalities in the bronchial walls, and guiding diagnostic procedures such as biopsy or needle aspiration.

2. Convex Probe EBUS (CP-EBUS)

CP-EBUS utilises a bronchoscope with a convex ultrasound probe located at the tip of the bronchoscope. Unlike RP-EBUS, CP-EBUS provides a forward-viewing ultrasound image, allowing for visualisation of structures directly ahead of the bronchoscope. CP-EBUS is commonly used for evaluating mediastinal lymph nodes, detecting abnormalities in the mediastinum, and guiding diagnostic procedures such as biopsy or needle aspiration.

Both RP-EBUS and CP-EBUS are valuable tools in the diagnosis and staging of lung cancer, assessment of mediastinal lymph nodes, evaluation of pulmonary lesions, and guidance of therapeutic interventions. The choice of EBUS technique may depend on the specific clinical scenario, the location and nature of the lesion or abnormality, and the expertise of the healthcare provider performing the procedure.

Why is EBUS Used?

EBUS is commonly used to diagnose and stage lung cancer, assess mediastinal lymph nodes for metastasis, and evaluate other conditions affecting the airways and surrounding tissues. It allows physicians to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery. The samples can be used for:

• Diagnosing and staging lung cancer.
• Diagnosing infections such as tuberculosis.
• Diagnosing inflammatory diseases such as sarcoidosis.
• Diagnosing other cancers such as lymphoma.

What Are the Benefits of an Endobronchial Ultrasound?

Endobronchial Ultrasound offers several benefits as a diagnostic and therapeutic tool for evaluating lung and mediastinal conditions. The key benefits of EBUS include:

• Minimally Invasive: EBUS is a minimally invasive procedure that can be performed using a flexible bronchoscope inserted through the mouth or nose, avoiding the need for more invasive surgical procedures.
• Real-time Imaging: EBUS provides real-time ultrasound imaging of the airways and surrounding structures, allowing healthcare providers to visualise abnormalities, such as tumours, lymph nodes, or lesions, with high resolution and accuracy.
• Precise Targeting: EBUS enables precise targeting of lesions or lymph nodes within the airways or mediastinum, facilitating accurate diagnosis, staging, and guidance of therapeutic interventions.
• Comprehensive Evaluation: EBUS allows for comprehensive evaluation of both central and peripheral pulmonary lesions, as well as mediastinal lymph nodes, providing valuable information for the diagnosis and management of lung cancer, infections, and other respiratory conditions.
• Reduced Need for Surgical Biopsy: EBUS can often provide sufficient diagnostic information without the need for more invasive surgical procedures, such as mediastinoscopy or thoracoscopy, reducing patient discomfort, recovery time, and healthcare costs.
• Quick Results: EBUS-guided procedures, such as biopsy or needle aspiration, can provide rapid results, allowing for timely diagnosis and treatment planning, which is particularly important in cases of suspected malignancy.
• Outpatient Procedure: EBUS is typically performed on an outpatient basis, allowing patients to return home the same day and resume normal activities shortly after the procedure, with minimal disruption to daily life.
• Cost-effective: Compared to other diagnostic procedures, EBUS is very cost effective and also has minimal complications.

Overall, EBUS is a valuable tool in the diagnosis and management of various pulmonary and mediastinal conditions, offering accurate, minimally invasive, and timely evaluation with fewer risks and complications compared to traditional surgical approaches.

What to Expect?

Before the Procedure

• Medical History Review: The doctor will review the patient’s medical history, including any underlying health conditions or allergies, and discuss any concerns they may have about the procedure.
• Consent: The patient (or their guardian) will be asked to sign a consent form, indicating that they understand the procedure, its risks, and benefits.
• Preparation: The doctor will provide instructions on how to prepare for the EBUS procedure. This may include fasting for a certain period before the procedure and temporarily stopping certain medications, such as blood thinners.
• Anaesthesia: EBUS is typically performed under sedation or general anaesthesia to ensure comfort and relaxation during the procedure.

During the Procedure

• Bronchoscope Insertion: A thin, flexible tube called a bronchoscope will be inserted through the patient’s mouth or nose and advanced into their airways. The bronchoscope is equipped with an ultrasound probe, which allows your healthcare provider to visualise the structures in the patient’s chest in real-time.
• Ultrasound Imaging: Your healthcare provider will use the ultrasound images to guide the bronchoscope to the target area within your chest, such as lymph nodes or masses, for further evaluation or biopsy.
• Biopsy or Aspiration: If needed, tissue samples may be obtained using specialised tools passed through the bronchoscope, such as needles or brushes, for analysis.

After the Procedure

• Recovery: After the procedure, you will be taken to a recovery area where you will be monitored closely as the effects of the sedation or anaesthesia wear off.
• Observation: Your healthcare provider will monitor you for any immediate complications or side effects, such as bleeding, difficulty breathing, or low blood pressure.
• Discharge Instructions: Once you are fully awake and stable, you will receive instructions on post-procedure care, including any restrictions on eating or drinking, medications, and follow-up appointments.
• Follow-up: You may be scheduled for a follow-up appointment to review the results of the procedure and discuss any further treatment or management plans, if needed.

What Are the Risks of an Endobronchial Ultrasound?

Endobronchial Ultrasound is generally considered a safe procedure, but like any medical procedure, it carries some risks. Common risks associated with EBUS may include:

• Bleeding: There is a risk of bleeding, particularly if a biopsy or needle aspiration is performed during the procedure. However, significant bleeding is rare and can usually be managed with local measures or medications.
• Infection: Although rare, there is a risk of infection following EBUS, particularly if the bronchoscope is inserted through the mouth or nose. Strict sterile techniques are used to minimise this risk.
• Airway Irritation: The insertion of the bronchoscope and manipulation within the airways may cause temporary irritation or discomfort, such as coughing or throat irritation. These symptoms typically resolve quickly after the procedure.
• Breathing Difficulties: Some individuals may experience temporary breathing difficulties or wheezing during or after the procedure, particularly if the airways are narrow or if there is underlying lung disease.
• Pneumothorax: In rare cases, EBUS may lead to a pneumothorax, which is the accumulation of air between the lung and the chest wall. This can cause chest pain and shortness of breath and may require treatment such as chest tube insertion.
• Allergic Reactions: There is a small risk of allergic reactions to medications or contrast agents used during the procedure, particularly if the individual has a history of allergies or sensitivities.
• Cardiac Events: Individuals with underlying heart conditions may be at increased risk of cardiac events, such as arrhythmias or heart attacks, during or after EBUS. Close monitoring and appropriate precautions are taken to minimise this risk.

Note: It's essential to discuss any concerns or potential risks with your healthcare provider before undergoing an EBUS procedure. Additionally, it is worth noting that the benefits of EBUS in diagnosing and staging lung cancer or other respiratory conditions outweigh the potential risks for most individuals.

If you or a loved one requires the diagnosis or management of respiratory conditions, consider seeking care at Max Hospital. As one of the pioneering centres in North India to offer EBUS, the Department of Interventional Pulmonology at Max Hospitals provide state-of-the-art facilities and expertise in performing this advanced diagnostic technique. Trust in the expertise and technology available at Max Hospitals for comprehensive and timely evaluation of your respiratory health needs.