OncologyTier 2Topic

Endobronchial ultrasound

Role

In oncology, EBUS-TBNA is used predominantly for mediastinal lymph node staging in lung cancer - sampling nodal stations to determine N-stage, which directly determines whether a patient is a surgical candidate (see EBUS procedures for the procedural/technical detail)
Has substantially reduced reliance on surgical mediastinoscopy for staging, given comparable diagnostic yield with lower invasiveness

Technique

Real-time ultrasound-guided needle sampling of mediastinal/hilar nodes via a bronchoscope-mounted probe

Nodal staging

Mediastinal nodal involvement (N2/N3 disease) generally precludes upfront surgical resection in favour of chemoradiotherapy - EBUS-guided nodal staging is therefore often the single investigation that determines the treatment pathway

A negative result

A negative EBUS-TBNA in a patient with high pre-test probability of nodal disease still warrants surgical staging (mediastinoscopy) given imperfect sensitivity - a negative result alone should not be used to proceed straight to surgery in this situation

Uses

Lung cancer staging, surgical resectability assessment, sarcoidosis/lymphoma as alternative causes of mediastinal lymphadenopathy

Why staging matters

Accurate nodal staging before treatment selection is one of the highest-yield single steps in lung cancer management, given how substantially it changes the treatment pathway

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