What is an Endobronchial Ultrasound?

How is an Endobronchial Ultrasound Done and Why?

view of the lungs showing where an endobronchial ultrasound may be done
What is an enobronchial ultrasound and how is it done?. istockphoto.com

What is an Endobronchial Ultrasound?

An endobronchial ultrasound is a medical procedure that may be performed during a bronchoscopy, to provide further information to diagnose or determine the stage of a lung cancer. This relatively new technique allows doctors to view regions of your lungs and surrounding chest area that have traditionally required more invasive surgical procedures to evaluate.

The procedure is usually performed as an outpatient procedure or a same day surgery and is considered a minimally invasive procedure.

What Happens During an Endobronchial Ultrasound?

An endobronchial ultrasound is usually performed under "procedural anesthesia" meaning that you will be very sleeping and won't feel uncomfortable, but will not be as deeply asleep as you would be with a general anesthetic. The procedure can, however, be done with a general anesthetic if needed.

Prior to doing an endobronchial ultrasound, your doctor will first do a bronchoscopy. In a bronchoscopy procedure, a tube is inserted through your mouth or nose into your trachea (your windpipe) and then into  the large airways leading into your lungs. After the tube is in place, doctors then use a special ultrasound probe to send sound waves (ultrasound) through the walls of your airways into the surrounding areas, including the lungs and mediastinum (the area of the chest that lies between the lungs).

If abnormal areas are seen on the ultrasound, your doctor can then take a sample of tissue with a small needle guided by the ultrasound.

This method of biopsy is termed a transbronchial needle ultrasound. A needle is introduced through the wall of your airway and into your lung tissue, while your doctor can watch in real time on ultrasound exactly where the needle is going  There is a small device on the end of this needle which can take a sample of any suspicious regions.

After your procedure is completed, the sample is then sent to a lab to look for the presence of cancer, or other abnormalities.

Why Would My Doctor Recommend an Endobronchial Ultrasound?

To recommend the best treatments for lung cancer, it is very important to understand the stage of a lung cancer – if, and how far, the cancer has spread. Accurate staging can reduce the amount of tissue that is removed during surgery for lung cancer. It may also spare you from going through unnecessary surgery if your cancer would be best treated another way, such as with chemotherapy, targeted therapies, immunotherapy, radiation therapy, or a combination of those treatments. 

Traditionally, accurate staging has often required invasive tests such as mediastinoscopy and other chest surgeries such as a thoracoscopy or thoracotomy. A thoracoscopy is a procedure that is similar to a laparoscopic surgery on the abdomen, only it is done on the chest. A thoracotomy is an open chest surgery which often involved cutting through and removing a portion of a rib or ribs.

 In some cases, an endobronchial ultrasound may give doctors the information they need to stage a cancer without having to recommend these more invasive procedures.

In addition to being a less invasive procedure, an endobronchial ultrasound may help doctors access difficult to reach areas. It can also sometimes identify more, and smaller lymph nodes than can be seen with a traditional mediastinoscopy.

There are four primary reasons your doctor may recommend an endobronchial ultrasound:

  • To look for the presence of tumors or enlarged lymph nodes.
  • To diagnose tumors within the lung.
  • To diagnose lymph nodes in the mediastinum (the area between the lungs) or hilum (the region near the top of the lungs.)
  • To diagnose tumors in the mediastinum.

In addition to diagnosing and staging lung cancer, an endobronchial ultrasound may also be used to detect infections or help to diagnose inflammatory lung conditions such as sarcoidosis.

After Your Endobronchial Ultrasound

Most people tolerate this procedure quite well and are able to leave the hospital on the same day the procedure is performed. This procedure does not require any incisions and is rapidly becoming a standard of care around the country.

Complications

Complications of an endobronchial ultrasound are primarily those which could occur due to a bronchoscopy or due to the biopsy itself. These can include bleeding, infection, the collapse of a lung, or complications related to the anesthetics given to do the procedure.

Sources:

Herth, F. Bronchoscopy/Endobronchial Ultrasound. Frontiers in Radiation Therapy and Oncology. 2010. 42:55-62.

Kinsey, L, and D. Arenberg. Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging. American Journal of Respiratory and Critical Care Medicine. 2014. 189(6):640-9.

Yasufuku, K. et al. Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer. General Thoracic and Cardiovascular Surgery. 2008. 56(6):268-76.

Yasufuku, K. Endobronchial ultrasound: Indications, contraindications, and complications. UpToDate. Updated 01/08/16. http://www.uptodate.com/contents/endobronchial-ultrasound-indications-contraindications-and-complications

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