In recent years, with the increasing use of chest CT scans in clinical practice, the detection rate of lung abnormalities has significantly risen. Many people have asked, "What does a lung shadow mean?" or "Is that small spot in my lung cancer?" This is because chest CT can only detect lung lesions; to determine their nature, tissue sampling is required. However, conventional bronchoscopy allows sampling only of lesions located within the trachea and bronchi, often leaving extrabronchial lesions inaccessible. In such cases, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be used for effective sampling.
 

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique that leverages the advantages of endobronchial ultrasound (EBUS) to directly sample and biopsy lung lesions using a needle.
What is EBUS
Endobronchial ultrasound (EBUS) is a revolutionary endoscopic technique that combines the advantages of conventional bronchoscopy with ultrasound technology, offering a new perspective for the diagnosis and treatment of pulmonary and mediastinal diseases. It plays an extremely important role in clinical practice, providing better medical services to patients.

1. Working Principle of EBUS
EBUS involves attaching a small ultrasound probe to the tip of a bronchoscope, enabling physicians to directly visualize structures surrounding the trachea and bronchi, including lymph nodes and tumors. This technique allows for precise localization and biopsy of suspected lesions without the need for open surgery.

2. Advantages of EBUS
(1) Minimally invasive: Compared to traditional mediastinoscopy, EBUS offers less trauma and faster recovery.
(2) High accuracy: The high-resolution ultrasound images provided by EBUS result in higher precision for sampling and biopsies.
(3) High safety: EBUS has fewer complications and is considered a relatively safe diagnostic method.
Case Sharing
Mr. Li visited our hospital complaining of dizziness and fatigue. During a routine chest CT scan, lung shadows accompanied by mediastinal lymphadenopathy were discovered. After multidisciplinary discussion, with support from the Anesthesiology Department, Operating Room, and Endoscopy Center, Associate Chief Physician Wang Guoliang and Dr. Yu Lingjun from the Pulmonary Disease Department performed an ultrasound-guided bronchoscopic transbronchial needle aspiration biopsy (EBUS-TBNA) on Mr. Li. Based on post-procedure pathological findings, the diagnosis was confirmed as small cell neuroendocrine carcinoma of the lung with lymph node metastasis. This timely and accurate diagnosis has paved the way for subsequent integrated traditional Chinese and Western medical treatment.
4R lymph node enhancement CT and EBUS examination
Enhanced CT and EBUS examination of 7 lymph node groups

Indications for EBUS-TBNA
1. Mediastinal and hilar lymph node staging in lung cancer

2. Mediastinal restaging of lung cancer

3. Diagnosis of lung tumors around the major airways
4. Diagnosis of mediastinal tumors
5. Diagnosis of sarcoidosis
6. Diagnosis of lymphoma
7. Molecular evaluation of mediastinal lymph nodes


Advantages of EBUS-TBNA
Clinically, due to the unique location and anatomy of the mediastinum and hilum, conditions such as pulmonary tuberculosis, tuberculous lymphadenitis, mediastinal tumors, sarcoidosis, and lung malignancies can all lead to enlargement or mass formation in the mediastinal and hilar lymph nodes. Diagnosing lesions in this region has long been a challenge for pulmonologists and thoracic surgeons. Currently, diagnostic evaluation of diseases involving the hilum and mediastinum primarily relies on imaging modalities such as chest CT, MRI, and PET-CT. These techniques first help identify the precise location of the lesion and analyze its relationship with surrounding blood vessels and lymph nodes, followed by definitive diagnosis through mediastinoscopy, thoracoscopy, lung biopsy, or conventional needle aspiration biopsy.

However, traditional needle aspiration biopsy, guided directly via bronchoscopy, involves inserting a biopsy needle through the tracheal mucosa between the thyroid cartilage rings into mediastinal lesions to obtain cytological and histological samples. Although this method holds significant value in diagnosing mediastinal diseases, it remains limited when evaluating lesions in the hilar region and enlarged lymph nodes. EBUS-TBNA, as a novel minimally invasive diagnostic technique, not only allows examination of the tracheal wall, extra-vascular structures, and mediastinal lymph nodes but also enables direct ultrasound-guided procedures. This approach effectively avoids the risks associated with conventional needle biopsies, expands the accessible examination area, clearly visualizes intramediastinal vascular distribution, lymph node enlargement, and the relationships among vessels, lymph nodes, and space-occupying lesions, thereby improving biopsy success rates, minimizing damage to adjacent vessels, and enhancing patient safety during the procedure.

We would like to remind everyone that once lung diseases are detected, they must be taken seriously. Through precise diagnostic techniques, early detection, and optimal treatment, we can achieve a "more with less" effect in diagnosis and therapy. The Pulmonary Department of Yantai Traditional Chinese Medicine Hospital is committed to providing more accurate, minimally invasive, and high-quality technologies and services to safeguard public health.



Contributed by the Department of Pulmonary Diseases