Table of ContentsView AllTable of ContentsPurposeTypesRisksBeforeDuringAfterResults
Table of ContentsView All
View All
Table of Contents
Purpose
Types
Risks
Before
During
After
Results
Endobronchial ultrasound (EBUS) is used for diagnosing lung cancer and certain inflammatory lung diseases that cannot be confirmed with standard imaging tests. The procedure can also help determine the stage of lung cancer.
EBUS is a minimally invasive procedure in which a flexible scope is inserted through the mouth and into the larger airways of the lungs (called thebronchi) to image tissues using high-frequency sound waves. Endobronchial ultrasound is typically performed on an outpatient basis.
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Uses and Purpose of Endobronchial Ultrasound
After alung cancer diagnosis(or if initial tests suggest it is lung cancer), endobronchial ultrasonography may be ordered alongside traditionalbronchoscopy. Unlike bronchoscopy, which directly visualizes theairwaysthrough a viewing scope, EBUS can help healthcare providers see beyond the airway tissues using refracted sound waves.
Endobronchial ultrasound can be used to determine the extent of tumor invasion in the central airways.
The two primary indications for EBUS include:
Endobronchial ultrasound is usually not the first tool a practitioner will turn to diagnose lung cancer. It is typically ordered when initial imaging tests and lab tests are strongly suggestive of the disease. EBUS is particularly useful in accessing amassornodulesituated near a major airway, saving your healthcare provider from having to go through the chest wall.
EBUS is most commonly used to stagenon-small cell lung cancers (NSCLC)but is being increasingly used to stagesmall cell lung cancers (SCLC), a less common form of the disease.
Limitations
As effective a tool as endobronchial ultrasound is, there is only a limited amount of lung tissue that it can visualize. While it is good at visualizing the upper and front portions of themediastinum(a space between the membrane lining the two lungs), it may not be able to see if thelung cancer has spread(metastasized) to other parts of the mediastinum.
EBUS is also sometimes used to diagnose lung infections, although its efficacy can vary. Withtuberculosis, endobronchial ultrasound can access hard-to-reach lymph nodes and establish whether the bacterial strain is resistant to available antibiotics. Even so, with a sensitivity of roughly 55% in people with tuberculosis, EBUS is prone to false-negative results in five of every 10 procedures.
Similar Tests
Prior to the introduction of endobronchial ultrasonography, the accurate staging of lung cancer required invasive procedures that accessed the lungs via the thorax (chest). These include such procedures as:
Endobronchial ultrasonography can provide healthcare providers with the information needed without the risks associated with surgery.
A 2015 study in theJournal of Thoracic Oncologyconcluded that EBUS withTBNA was superior to mediastinoscopy in the staging of non-small cell lung cancer and should be regarded as the first-line procedure for such purposes.
Depending on what your healthcare provider is evaluating, you may receive one of two different types of EBUS tests. Your healthcare provider may also want to perform a biopsy during your EBUS test.
EBUS vs. BronchoscopyBronchoscopy describes any procedure in which a bronchoscope is used to obtain images of the lungs. EBUS is a type of bronchoscopy that uses ultrasound to obtain these images.
EBUS vs. Bronchoscopy
Bronchoscopy describes any procedure in which a bronchoscope is used to obtain images of the lungs. EBUS is a type of bronchoscopy that uses ultrasound to obtain these images.
Risks and Contraindications
The risks and contraindications for endobronchial ultrasonography are similar to those of bronchoscopy. Some are mild and transient, resolving without treatment, while others require medical intervention.
The most common risks of endobronchial ultrasound include:
Because anesthesia is required, people may also experience nausea, vomiting, muscle pain, blood pressure changes, andbradycardia(slowed heart rate).
Ultrasound is contraindicated in people with the following health conditions:
Before the Procedure
Like bronchoscopy, endobronchial ultrasonography is generally considered safe with a relatively low risk of complications. Knowing what to expect can help you prepare.
Timing
Even though the EBUS procedure takes only around 20 to 30 minutes to perform, it can take up to four hours to prepare for the procedure and recover from the anesthesia.It is best to clear your schedule on the day of your procedure and arrange for one more day off so you can rest and recuperate.
Location
Endobronchial ultrasound is performed in an operating room or special procedure suite of a hospital. The room is equipped with an electrocardiogram (ECG) machine to monitor your heart rate and aventilatorto deliver supplemental oxygen if needed.
What to Wear
As you will be asked to change into a hospital gown, dress comfortably in clothes that can be easily removed and put back on. It is best to leave any jewelry or valuables at home.
Also be prepared to remove any dentures, hearing aids, contact lenses, or eyeglasses before the procedure. You will be given a secure place to store these along with your clothing and other belongings.
Food and Drink
In most cases, you will be asked to stop eating at midnight the day before the procedure. Most EBUS procedures are scheduled in the morning so that you don’t get excessively hungry. If the procedure is scheduled later in the day, the healthcare provider may advise you to stop eating six hours beforehand.
You can only drinkwater (no tea, coffee, or other liquids) up to two hours before the procedure. In the final two hours, do not eat or drink anything.
Your healthcare provider will also advise you about which drugs you need to stop prior to endobronchial ultrasound. Some medications can interfere with coagulation (blood clotting), leading to excessive bleeding and poor wound healing. Others may cause the excessive and harmful build-up oflactic acid in the blood.
Some of the drugs of concern include:
Some of these medications may need to be stopped a week in advance, while others only need to be discontinued on the day of the procedure. Advise your healthcare provider about any and all drugs you take to avoid potential harm.
EBUS Test Cost and Health Insurance
Prior authorizationis required from your medical insurer before EBUS can be covered. To estimate your out-of-pocket expense, check thecopay or coinsuranceprovisions in your policy before or after thedeductible.
What to Bring
Be sure to bring your insurance card, an official form of identification (such as your driver’s license), and an approved form of payment if copay/coinsurance fees are required upfront. Because there may be waiting time, think about bringing something to read or occupy yourself with.
Other Considerations
Because anesthesia is involved, you will need to bring someone with you to drive you home. Some facilities will not allow you to leave unless you have organized transport, ideally with a friend or family member who can escort you inside your house and stay with you overnight.
EBUS Procedure
Pre-Test
You will need to complete aconsent formand disclose any medications you’re taking and adverse reactions you’ve experienced. Your anesthesiologist will ask you about any allergies you have or adverse reactions you’ve experienced with anesthesia. The healthcare provider should also advise about thetype of anesthesiabeing used and what to expect afterward.
Shortly before the procedure, the nurse will insert an intravenous (IV) line into a vein in your arm through which anesthesia and other medications can be delivered. You will also have adhesive probes attached to your chest to monitor your heartbeat on the ECG machine. Apulse oximeterwill be placed on your finger to monitor your blood oxygen levels.
Throughout the Test
Endobronchial ultrasound is usually performed under procedural anesthesia, meaning that you will experience a “twilight sleep” but not sleep as deeply as you would with ageneral anesthetic(although one can be used, if needed).
Before the endobronchial ultrasound begins, the healthcare provider will first perform a regular bronchoscopy to visually examine the airways. The device will then be removed and replaced with an EBUS bronchoscope.
Unlike a regular bronchoscope, an EBUS bronchoscope can help a practitioner differentiate between normal and cancerous tissues because of the visual patterns it can project on the video monitor.
If an abnormal mass, lesion, or lymph node is found, the healthcare provider can obtain a tissue sample with the transbronchial aspiration needle.
After the Procedure
Most people tolerate endobronchial ultrasound well and are able to leave the hospital on the same day. Even so, it is not uncommon to experience nausea and feel unsteady due to the anesthesia.
Sore throat, hoarseness, and coughing are also common, although they tend to be mild and resolve in a day or so. You may also have pinkish or reddish phlegm if a biopsy was performed, but this is normal and usually of little concern.
After returning home, it is best to relax and take it easy for a day or so. You should not drive or operate heavy machinery for at least 24 hours following the procedure.
If you experience any unusual, persistent, or worsening symptoms—including fever, chills, coughing up blood, or trouble breathing—call your healthcare provider immediately. These may besigns of an infection.
If you experience rapid or irregular heart, chest tightness and pain, pain in the jaw or arm, lightheadedness, and shortness of breath after undergoing EBUS, call 911. These could besigns of a heart attack.
Interpreting Results
If the procedure was used to stage lung cancer, your healthcare provider will discuss the results of the transbronchial biopsy with you. The information may include:
These pieces of information can be used to stage and grade the disease, as well as ensure appropriate treatment.
If used for diagnostic purposes, EBUS results would detail what, if any, abnormalities were found in the histology.
Summary
Endobronchial ultrasound is used to diagnose or stage lung cancer or to diagnose certain inflammatory lung conditions. It is a minimally invasive procedure that can be done on an outpatient basis.
EBUS involves inserting a flexible tube into the airways to obtain images of them that your healthcare provider can use to identify lesions in the lungs. They may also take a biopsy during the procedure.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kuijvenhoven JC, Livi V, Morandi L, Cancellieri A, Annema JT, Trisolini R.The expanding role of endobronchial ultrasound in patients with centrally located intrapulmonary tumors.Lung Cancer. 2019;134:194-201. doi:10.1016/j.lungcan.2019.06.006Fielding D, Kurimoto N.Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis and staging of lung cancer.Clin Chest Med. 2018;39(1):111-123. doi:10.1016/j.ccm.2017.11.012Jalil BA, Yasufuku K, Khan AM.Uses, limitations, and complications of endobronchial ultrasound.Proc (Bayl Univ Med Cent). 2015;28(3):325-30. doi:10.1080/08998280.2015.11929263Kang HK, Um SW, Jeong BH, et al.The utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with small-cell lung cancer.Intern Med. 2016;55(9):1061-6. doi:10.2169/internalmedicine.55.6082Dugdale I, Tan SL, Niazi M, Lal A, Niazi MB.Diagnostic yield and safety of EBUS-TBNA: single centre experience over 10 years.Eur Respir J.2023;62:PA1793. doi:10.1183/13993003.congress-2023.PA1793Jantz MA.Lung cancer staging: accuracy is critical.J Thorac Dis. 2019;11(Suppl 9):S1322-4. doi:10.21037/jtd.2019.04.18Um SW, Kim HK, Jung SH, et al.Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer.J Thorac Oncol.2015;10(2):331-7. doi:10.1097/JTO.0000000000000388Avasarala SK, Aravena C, Almeida FA.Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications.J Thorac Dis. 2020;12(3):1085-1099. doi:10.21037/jtd.2019.10.76City of Hope.EBUS procedure.Verdial FC, Berfield KS, Wood DE, Mulligan MS, Roth JA, Francis DO, Farjah F.Safety and costs of endobronchial ultrasound-guided nodal aspiration and mediastinoscopy.Chest. 2020;157(3):686-693. doi:10.1016/j.chest.2019.09.021Haentschel M, Boeckeler M, Bonzheim I, et al.Influence of biopsy technique on molecular genetic tumor characterization in non-small cell lung cancer-the prospective, randomized, single-blinded, multicenter PROFILER study protocol.Diagnostics (Basel). 2020;10(7):459. doi:10.3390/diagnostics10070459Stevic R, Milenkovic B.Tracheobronchial tumors.J Thorac Dis. 2016;8(11):3401-13. doi:10.21037/jtd.2016.11.24
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kuijvenhoven JC, Livi V, Morandi L, Cancellieri A, Annema JT, Trisolini R.The expanding role of endobronchial ultrasound in patients with centrally located intrapulmonary tumors.Lung Cancer. 2019;134:194-201. doi:10.1016/j.lungcan.2019.06.006Fielding D, Kurimoto N.Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis and staging of lung cancer.Clin Chest Med. 2018;39(1):111-123. doi:10.1016/j.ccm.2017.11.012Jalil BA, Yasufuku K, Khan AM.Uses, limitations, and complications of endobronchial ultrasound.Proc (Bayl Univ Med Cent). 2015;28(3):325-30. doi:10.1080/08998280.2015.11929263Kang HK, Um SW, Jeong BH, et al.The utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with small-cell lung cancer.Intern Med. 2016;55(9):1061-6. doi:10.2169/internalmedicine.55.6082Dugdale I, Tan SL, Niazi M, Lal A, Niazi MB.Diagnostic yield and safety of EBUS-TBNA: single centre experience over 10 years.Eur Respir J.2023;62:PA1793. doi:10.1183/13993003.congress-2023.PA1793Jantz MA.Lung cancer staging: accuracy is critical.J Thorac Dis. 2019;11(Suppl 9):S1322-4. doi:10.21037/jtd.2019.04.18Um SW, Kim HK, Jung SH, et al.Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer.J Thorac Oncol.2015;10(2):331-7. doi:10.1097/JTO.0000000000000388Avasarala SK, Aravena C, Almeida FA.Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications.J Thorac Dis. 2020;12(3):1085-1099. doi:10.21037/jtd.2019.10.76City of Hope.EBUS procedure.Verdial FC, Berfield KS, Wood DE, Mulligan MS, Roth JA, Francis DO, Farjah F.Safety and costs of endobronchial ultrasound-guided nodal aspiration and mediastinoscopy.Chest. 2020;157(3):686-693. doi:10.1016/j.chest.2019.09.021Haentschel M, Boeckeler M, Bonzheim I, et al.Influence of biopsy technique on molecular genetic tumor characterization in non-small cell lung cancer-the prospective, randomized, single-blinded, multicenter PROFILER study protocol.Diagnostics (Basel). 2020;10(7):459. doi:10.3390/diagnostics10070459Stevic R, Milenkovic B.Tracheobronchial tumors.J Thorac Dis. 2016;8(11):3401-13. doi:10.21037/jtd.2016.11.24
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kuijvenhoven JC, Livi V, Morandi L, Cancellieri A, Annema JT, Trisolini R.The expanding role of endobronchial ultrasound in patients with centrally located intrapulmonary tumors.Lung Cancer. 2019;134:194-201. doi:10.1016/j.lungcan.2019.06.006Fielding D, Kurimoto N.Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis and staging of lung cancer.Clin Chest Med. 2018;39(1):111-123. doi:10.1016/j.ccm.2017.11.012Jalil BA, Yasufuku K, Khan AM.Uses, limitations, and complications of endobronchial ultrasound.Proc (Bayl Univ Med Cent). 2015;28(3):325-30. doi:10.1080/08998280.2015.11929263Kang HK, Um SW, Jeong BH, et al.The utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with small-cell lung cancer.Intern Med. 2016;55(9):1061-6. doi:10.2169/internalmedicine.55.6082Dugdale I, Tan SL, Niazi M, Lal A, Niazi MB.Diagnostic yield and safety of EBUS-TBNA: single centre experience over 10 years.Eur Respir J.2023;62:PA1793. doi:10.1183/13993003.congress-2023.PA1793Jantz MA.Lung cancer staging: accuracy is critical.J Thorac Dis. 2019;11(Suppl 9):S1322-4. doi:10.21037/jtd.2019.04.18Um SW, Kim HK, Jung SH, et al.Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer.J Thorac Oncol.2015;10(2):331-7. doi:10.1097/JTO.0000000000000388Avasarala SK, Aravena C, Almeida FA.Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications.J Thorac Dis. 2020;12(3):1085-1099. doi:10.21037/jtd.2019.10.76City of Hope.EBUS procedure.Verdial FC, Berfield KS, Wood DE, Mulligan MS, Roth JA, Francis DO, Farjah F.Safety and costs of endobronchial ultrasound-guided nodal aspiration and mediastinoscopy.Chest. 2020;157(3):686-693. doi:10.1016/j.chest.2019.09.021Haentschel M, Boeckeler M, Bonzheim I, et al.Influence of biopsy technique on molecular genetic tumor characterization in non-small cell lung cancer-the prospective, randomized, single-blinded, multicenter PROFILER study protocol.Diagnostics (Basel). 2020;10(7):459. doi:10.3390/diagnostics10070459Stevic R, Milenkovic B.Tracheobronchial tumors.J Thorac Dis. 2016;8(11):3401-13. doi:10.21037/jtd.2016.11.24
Kuijvenhoven JC, Livi V, Morandi L, Cancellieri A, Annema JT, Trisolini R.The expanding role of endobronchial ultrasound in patients with centrally located intrapulmonary tumors.Lung Cancer. 2019;134:194-201. doi:10.1016/j.lungcan.2019.06.006
Fielding D, Kurimoto N.Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis and staging of lung cancer.Clin Chest Med. 2018;39(1):111-123. doi:10.1016/j.ccm.2017.11.012
Jalil BA, Yasufuku K, Khan AM.Uses, limitations, and complications of endobronchial ultrasound.Proc (Bayl Univ Med Cent). 2015;28(3):325-30. doi:10.1080/08998280.2015.11929263
Kang HK, Um SW, Jeong BH, et al.The utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with small-cell lung cancer.Intern Med. 2016;55(9):1061-6. doi:10.2169/internalmedicine.55.6082
Dugdale I, Tan SL, Niazi M, Lal A, Niazi MB.Diagnostic yield and safety of EBUS-TBNA: single centre experience over 10 years.Eur Respir J.2023;62:PA1793. doi:10.1183/13993003.congress-2023.PA1793
Jantz MA.Lung cancer staging: accuracy is critical.J Thorac Dis. 2019;11(Suppl 9):S1322-4. doi:10.21037/jtd.2019.04.18
Um SW, Kim HK, Jung SH, et al.Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer.J Thorac Oncol.2015;10(2):331-7. doi:10.1097/JTO.0000000000000388
Avasarala SK, Aravena C, Almeida FA.Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications.J Thorac Dis. 2020;12(3):1085-1099. doi:10.21037/jtd.2019.10.76
City of Hope.EBUS procedure.
Verdial FC, Berfield KS, Wood DE, Mulligan MS, Roth JA, Francis DO, Farjah F.Safety and costs of endobronchial ultrasound-guided nodal aspiration and mediastinoscopy.Chest. 2020;157(3):686-693. doi:10.1016/j.chest.2019.09.021
Haentschel M, Boeckeler M, Bonzheim I, et al.Influence of biopsy technique on molecular genetic tumor characterization in non-small cell lung cancer-the prospective, randomized, single-blinded, multicenter PROFILER study protocol.Diagnostics (Basel). 2020;10(7):459. doi:10.3390/diagnostics10070459
Stevic R, Milenkovic B.Tracheobronchial tumors.J Thorac Dis. 2016;8(11):3401-13. doi:10.21037/jtd.2016.11.24
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