The Role of EBUS-TBNA in the Diagnosis and Staging of Lung Cancer

Sang-Won Um

doi:10.7599/hmr.2014.34.1.20

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Um: The Role of EBUS-TBNA in the Diagnosis and Staging of Lung Cancer

Review Article

Hanyang Medical Reviews 2014; 34(1): 20-25.

Published online: 25 February 2014

DOI: https://doi.org/10.7599/hmr.2014.34.1.20

The Role of EBUS-TBNA in the Diagnosis and Staging of Lung Cancer

Sang-Won Um

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Sang-Won Um. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3429, Fax: +82-2-3410-3849, sangwonum@skku.edu

Received 1 November 2013 Revised 13 January 2014 Accepted 21 January 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Convex-probe endobronchial ultrasound-guided transbronchial needle aspiration (CP-EBUS-TBNA) has emerged as a new diagnostic modality that allows ultrasound-guided, real-time needle aspiration of mediastinal and hilar lymph nodes. Mediastinoscopy has been the reference standard for neoplastic staging in the mediastinum, but it is invasive and requires general anesthesia. Considering recent prospective studies and clinical guidelines, a needle technique such as EBUS-TBNA and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) should be performed first for the mediastinal nodal staging of non-small lung cancer. Combining EBUS-TBNA and EUS-FNA will replace more invasive methods such as mediastinoscopy. CP-EBUS-TBNA can also be used for the restaging after neoadjuvant therapy, the diagnosis of recurrent lung cancer and central lung parenchymal lesion which abuts trachea or bronchi. In the era of personalized medicine, good-quality and sufficient tissues need to be obtained for the molecular testing and treatment guidance. EBUS-TBNA has the ability to obtain satisfactory material for the detection of EGFR mutation, KRAS mutation, and EML-ALK fusion gene.

Keywords: Endoscopic Ultrasound-Guided Fine Needle Aspiration, Lung Neoplasms, Mediastinum, Lymph node, Neoplasm Metastasis

Figures and Tables

Fig. 1

EBUS bronchoscope and puncture needle. (A) Tip of ultrasound puncture bronchoscope. (B) Inflated balloon with saline and 22-guaze TBNA needle.

Fig. 2

Ultrasound images of EBUS-TBNA procedures. (A) Linear ultrasound image (needle in the lymph node) is a 50° slice in parallel to the long axis of the bronchoscope. (B) Power Doppler image can differentiate the vascular shadow (PA & AO) from lymph node (4L).

Fig. 3

CP-EBUS-TBNA for the central parenchymal lung mass. (A) Lung parenchymal mass at right upper lobe which abuts the trachea. (B) Linear ultrasound image of the mass (needle in the mass).

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