EBUS TBNA for Diagnosis and Staging of Lung Cancer

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS TBNA) is the accepted first test in the pretreatment staging of lung cancer suitable for curative therapy. Virtually all patients having Surgery or Radical Radiotherapy should undergo the procedure, with the exception of clinical Stage 1A patients. Even cases with tumors larger than 3cm (Stage 2 and greater) who have a CT and PET clear mediastinum should have EBUS TBNA staging. Clinical (CT and PET) negative mediastinal nodes have an incidence of occult metastatic disease of over 20%. Technical aspects of EBUS TBNA are becoming standardized given its now over 10 years of use in the clinical setting. Rapid on site examination of EBUS TBNA samples can be extremely helpful in the performance of staging procedures particularly to allow curtailment of the procedure once malignant cells are detected. EBUS TBNA can be used to make the diagnosis of lung cancer especially where the mass is adjacent a proximal airway. EBUS TBNA material is ideally suited to be used for genetic analysis of malignant cases and this feature alone ensures EBUS TBNA will continue to have a central role in the management of lung cancer patients.

Keywords: Bronchoscopy, Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS TBNA), Lung cancer, Mediastinal nodes, Occult metastatic disease, Radical Radiotherapy, Rapid-on-site-evaluation (ROSE).