Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive mediastinal staging tool for lung cancer but also a diagnostic tool for mediastinal lesions near the airway. This review focuses on the technique of linear probe EBUS-TBNA, clinical indications and utility, comparative factors with respect to other mediastinal sampling techniques; and training and financial issues. This review will be relevant to centres considering establishing an EBUS-TBNA service especially in healthcare systems which are resource-limited and rationed.
EBUS-TBNA is commonly used for lung cancer staging and diagnosis, specifically non-small cell lung cancer (NSCLC). It is often used for both diagnosis and staging in the setting of bulky mediastinal lymphadenopathy with enlarged N2 or N3 disease on cross-sectional imaging, but is also used for diagnosis of unexplained mediastinal lymphadenopathy and lesions near the airway due to other (often non-malignant) causes. When there is radical treatment intent, many centres still perform cervical mediastinoscopy (CM) first line as the staging procedure and this should certainly be done to corroborate negative EBUS-TBNA results in this scenario or when the clinical probability of lung cancer is high. EBUSTBNA may be increasingly used in the future for staging when the “normal” (according to cross-sectional imaging) mediastinum and also in re-staging. It has a long learning curve requiring appropriate training and mentorship; it offers numerous advantages over CM including being less invasive and reducing operational costs. Long may it continue as one of the interventional pulmonologist’s main tools.