Advertisement

Linear Endobronchial Ultrasound

  • Kazuhiro YasufukuEmail author
Chapter

Abstract

Linear endobronchial ultrasound (EBUS) also known as the convex probe endobronchial ultrasound (CP-EBUS) is a flexible bronchoscope with a linear ultrasound probe on the tip. It allows real-time EBUS-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar structures under ultrasound control. A dedicated 21- or 22-gauge needle is used for EBUS-TBNA. This minimally invasive procedure is an evolving diagnostic tool which allows the bronchoscopists to see beyond the airway and at the same time perform diagnostics. Clinical applications of EBUS-TBNA includes (a) lymph node staging in lung cancer patients, (b) diagnosis of intrapulmonary tumors, (c) diagnosis of unknown hilar and/or mediastinal lymphadenopathy, and (d) diagnosis of mediastinal tumors. The reach of EBUS-TBNA is comparable to mediastinoscopy which is still considered to be the “gold standard” of mediastinal staging but also extends to the hilar lymph nodes. High diagnostic yield has been achieved with EBUS-TBNA for lymph node staging in lung cancer. Data show that it is less invasive, safer than, and as accurate as surgical staging in lung cancer patients with discrete mediastinal lymph node enlargement. The diagnosis of mediastinal/hilar adenopathy of unknown origin may sometimes be challenging due to the limitation of the size of the needles available for EBUS-TBNA. Rapid on-site cytological evaluation is not always necessary during EBUS-TBNA, but it allows determination of whether sampling of the target has been achieved. More importantly, it allows triage of aspirate materials to secondary investigations (culture for granulomatous disease, flow cytometry for lymphoma). EBUS-TBNA is a novel approach which can be safely performed in an ambulatory setting with a high diagnostic yield.

Keywords

Hilar Lymph Node Azygos Vein Brachiocephalic Artery Mediastinal Lymphadenopathy Endobronchial Ultrasound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Adams K, Shah PL, Edmonds L, et al. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax. 2009;64:757–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J. 2009;33:1156–64.PubMedCrossRefGoogle Scholar
  3. 3.
    Detterbeck FC, Jantz MA, Wallace M, et al. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd ed). Chest. 2007;132(3 Suppl):202S–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Rusch VW, Asamura H, Watanabe H, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:568–77.PubMedCrossRefGoogle Scholar
  5. 5.
    Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer. 2005;50:347–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Herth FJ, Eberhardt R, Vilmann P, et al. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61:795–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Herth FJ, Ernst A, Eberhardt R, et al. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. Eur Respir J. 2006;28:910–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Wada H, Nakajima T, Yasufuku K, Fujiwara T, Yoshida S, Suzuki M, Shibuya K, Hiroshima K, Nakatani Y, Yoshino I. Lymph node staging by endobronchial ultrasound-guided transbronchial needle aspiration in patients with small cell lung cancer. Ann Thorac Surg. 2010;90:229–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Yasufuku K, Nakajima T, Motoori K, et al. Comparison of endobronchial ultrasound, positron emission tomography, and computed tomography for lymph node staging of lung cancer. Chest. 2006;130:710–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Herth FJ, Annema JT, Eberhardt R, et al. Endobronchial ultrasound with transbronchial needle aspiration for restaging the mediastinum in lung cancer. J Clin Oncol. 2008;26:3346–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Wallace MB, Pascual JM, Raimondo M, et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA. 2008;299:540–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Herth FJ, Krasnik M, Kahn N, et al. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138:790–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Ernst A, Anantham D, Eberhardt R, et al. Diagnosis of mediastinal adenopathy – real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. J Thorac Oncol. 2008;3:577–82.PubMedCrossRefGoogle Scholar
  14. 14.
    Yasufuku K, Pierre A, Darling G, et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142(6):1393–1400.Google Scholar
  15. 15.
    Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA. 2010;304:2245–52.PubMedCrossRefGoogle Scholar
  16. 16.
    Wong M, Yasufuku K, Nakajima T, et al. Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis. Eur Respir J. 2007;29:1–6.CrossRefGoogle Scholar
  17. 17.
    Tremblay A, Stather DR, Maceachern P, et al. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest. 2009;136:340–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Nakajima T, Yasufuku K, Kurosu K, et al. The role of EBUS-TBNA for the diagnosis of sarcoidosis – comparisons with other bronchoscopic diagnostic modalities. Respir Med. 2009;103:1796–800.PubMedCrossRefGoogle Scholar
  19. 19.
    Kennedy MP, Jimenez CA, Bruzzi JF, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax. 2008;63:360–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Yasufuku K, Nakajima T, Fujiwara T, et al. Utility of EBUS-TBNA in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg. 2011;91:831–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Nakajima T, Yasufuku K, Fujiwara T, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrapulmonary lesions. J Thorac Oncol. 2008;3:985–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Tournoy KG, Rintoul RC, van Meerbeeck JP, et al. EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy. Lung Cancer. 2009;63:45–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Herth F, Krasnik M, Yasufuku K, et al. Endobronchial ultrasound-guided transbronchial needle aspiration – how I do it. J Bronchol. 2006;13:84–91.CrossRefGoogle Scholar
  24. 24.
    Sarkiss M, Kennedy M, Riedel B, et al. Anesthesia technique for endobronchial ultrasound-guided fine needle aspiration of mediastinal lymph node. J Cardiothorac Vasc Anesth. 2007;21:892–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Fujiwara T, Yasufuku K, Nakajima T, et al. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest. 2010;138:641–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Nakajima T, Yasufuku K. How I do it – optimal methodology for multidirectional analysis of endobronchial ultrasound-guided transbronchial needle aspiration samples. J Thorac Oncol. 2011;6:203–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Yasufuku K, Nakajima T. Endobronchial ultrasound guided transbronchial needle aspiration manual. Yasufuku K, editor. Tokyo: Kanehara Shuppan; 2009.Google Scholar
  28. 28.
    Nakajima T, Yasufuku K, Suzuki M, et al. Assessment of epidural growth factor receptor mutation by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2007;132:597–602.PubMedCrossRefGoogle Scholar
  29. 29.
    Mohamed S, Yasufuku K, Nakajima T, et al. Analysis of cell cycle-related proteins in mediastinal lymph nodes of N2-NSCLC patients obtained by EBUS-TBNA: relevance to chemotherapy response. Thorax. 2008;63:642–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Sakairi Y, Nakajima T, Yasufuku K, et al. EML4-ALK fusion gene assessment using metastatic lymph node samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration. Clin Cancer Res. 2010;16:4938–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Thoracic SurgeryToronto General Hospital, University Health Network, University of TorontoTorontoCanada

Personalised recommendations