Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA)

Sometimes lung problems remain unexplained even after routine tests such as blood work or CT scans. Imaging may show enlarged lymph nodes inside the chest, but scans alone cannot always identify the exact cause.

In these situations, doctors may advise Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA). The procedure allows doctors to obtain small tissue samples from lymph nodes near the airways. Examining these samples in the laboratory can help doctors determine whether the changes are related to infection, inflammation, or cancer.

EBUS-TBNA is performed during bronchoscopy using ultrasound imaging. The ultrasound probe allows the doctor to see lymph nodes and nearby structures within the chest while the bronchoscope is in place. This helps guide the needle accurately to the sampling area. The procedure requires specialised equipment and is usually performed by pulmonologists trained in advanced bronchoscopy.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA), commonly called EBUS-TBNA, is a diagnostic procedure used to obtain tissue samples from lymph nodes and other structures in the mediastinum, the area between the lungs.

EBUS-TBNA is usually performed during a bronchoscopy. A flexible bronchoscope fitted with a miniature ultrasound probe is gently introduced through the mouth or nose and advanced into the airways. The bronchoscope allows the doctor to see the airway passages, while the ultrasound provides images of lymph nodes and other structures located just outside the airway walls.

When a lymph node or abnormal area is identified, the doctor guides a thin needle through the bronchoscope to reach that location. Small tissue samples are taken from the selected node or tissue. These samples are then sent to the laboratory, where they are examined under a microscope and, if necessary, tested further.

In the past, accessing lymph nodes in the mediastinum often required surgical procedures such as mediastinoscopy. With ultrasound guidance during bronchoscopy, many of these areas can now be sampled using a minimally invasive approach.

Doctors may advise EBUS-TBNA when imaging studies show lymph nodes or other findings in the chest that need closer assessment. CT or PET scans can identify enlarged nodes, but they cannot always explain the cause of these changes. In these situations, doctors may need a small tissue sample from the lymph node to understand what is causing the change.

EBUS-TBNA may be considered in situations such as:

• Enlarged lymph nodes noted on CT or PET imaging

• Assessment when lung cancer is being considered

• Determining whether cancer has spread to nearby lymph nodes

• Evaluation of unexplained findings within the mediastinum

• Review of inflammatory diseases such as sarcoidosis

• Assessment of infections that may involve lymph nodes in the chest

• Cases where earlier investigations have not explained the imaging findings

The collected tissue is examined in the laboratory. The report helps the treating doctor interpret the abnormal finding and decide the next step in care.

Not every patient with respiratory symptoms requires EBUS-TBNA. Doctors decide whether the procedure is appropriate after reviewing the patient’s symptoms, imaging results, and earlier test reports.

Patients who may be considered for EBUS-TBNA include:

• People whose imaging tests show enlarged mediastinal lymph nodes

• Patients being evaluated for suspected lung cancer

• Individuals who require lymph node sampling to determine cancer staging

• Patients with possible inflammatory lung conditions such as sarcoidosis

• Situations where doctors need tissue confirmation before starting treatment

• Cases where earlier tests have not explained the findings seen on scans

In many cases, EBUS-TBNA allows doctors to obtain the required sample without performing surgery.

EBUS-TBNA is regarded as a safe diagnostic procedure. Even so, it may not be suitable for every patient. Before advising the test, doctors review the patient’s general condition and ongoing medical issues.

The procedure may not be performed in patients who:

• Have significant breathing difficulty

• Have bleeding disorders that increase the risk of bleeding

• Are clinically unstable during evaluation

• Have heart conditions that need medical stabilisation first

In such cases, doctors at Gleneagles Hospitals first stabilise the patient or consider another investigation depending on the clinical situation.

An experienced pulmonologist performs EBUS-TBNA with assistance from nursing and anaesthesia teams. At Gleneagles Hospitals, the test is performed in a bronchoscopy suite, where patients are monitored throughout the procedure.

Before the procedure, the doctor talks with the patient about why the test has been recommended and what it may help show. This is also the time for patients to ask any questions about the procedure.

The care team reviews the patient’s medical history, current medications, and previous reports. Blood tests and imaging results are usually reviewed before the procedure is planned.

Patients are generally asked to:

• Avoid eating or drinking for a few hours before the test

• Let the doctor know if they take blood-thinning medicines

• Avoid smoking before the procedure

At Gleneagles Hospitals, these instructions are explained during the preparation stage.

• The throat or nasal passage is first numbed with local anaesthesia. Some patients may also receive a mild sedative to help them stay comfortable.

• A bronchoscope equipped with a small ultrasound probe is then carefully passed into the airways. The ultrasound images help the doctor identify lymph nodes and nearby areas.

• Once the area to be sampled is located, a fine needle is passed through the bronchoscope to obtain small tissue samples that are collected from the lymph node or selected area. The doctor may repeat this step to obtain enough material for laboratory analysis.

• Mild coughing during bronchoscopy is common. Oxygen levels and heart rate are monitored throughout the test.

• The procedure usually takes about 30 to 45 minutes, although the duration can vary depending on the number of samples required.

After the procedure, patients are kept under observation for a short time while the effects of sedation wear off. Eating or drinking is usually postponed until the numbness in the throat has settled.

Some temporary symptoms may occur, including:

• Mild sore throat

• Temporary cough

• Hoarseness of voice

• Mild tiredness related to sedation

• These effects generally settle within a short period.

Most patients can return home the same day. The tissue samples collected during the procedure are sent to the laboratory for analysis. Depending on the tests required, results may take a few days to become available.

EBUS-TBNA helps doctors obtain tissue samples from lymph nodes within the chest without performing open surgery.

The procedure may help doctors to:

• Examine mediastinal lymph nodes

• Diagnose lung cancer and determine its stage

• Identify inflammatory lung diseases

• Detect infections affecting lymph nodes in the chest

• Guide treatment decisions based on tissue findings

Because it is minimally invasive, most patients recover quickly after the procedure.

Endobronchial ultrasound-guided transbronchial needle aspiration allows doctors to examine lymph nodes and nearby structures around the airways. During the procedure, bronchoscopy with ultrasound guidance is used to obtain small tissue samples from areas within the chest that are otherwise difficult to access.

The collected samples are then examined in the laboratory to check for infection, inflammation, or cancer. At Gleneagles Hospitals, doctors suggest EBUS-TBNA only when it is needed to clarify the diagnosis.