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Interventional
Endobronchial Ultrasound (EBUS)
Added by Dr. Andrew · Last updated 2024-01-15
Overview
EBUS combines bronchoscopy with ultrasound to enable real-time guided sampling of mediastinal and hilar lymph nodes and masses. Linear EBUS-TBNA has largely replaced mediastinoscopy for mediastinal staging of lung cancer and diagnosis of mediastinal lymphadenopathy.
Key Points
- 1Linear (convex probe) EBUS: real-time TBNA of mediastinal/hilar nodes — stations 2R, 2L, 4R, 4L, 7, 10R, 10L, 11R, 11L
- 2Radial EBUS: for peripheral pulmonary lesions — guide sheath technique for TBB
- 3Indications: mediastinal staging of NSCLC, diagnosis of mediastinal lymphadenopathy (sarcoidosis, lymphoma, metastasis), peripheral lung lesion biopsy
- 4Sensitivity for mediastinal malignancy: ~90% (superior to CT/PET alone)
- 5Rapid on-site evaluation (ROSE): cytopathologist evaluates adequacy in real-time — improves yield
- 6Complications: rare — bleeding, infection, pneumothorax <1%
Clinical Pearls
- Cannot access stations 5 and 6 (aortopulmonary window) — need EUS or mediastinoscopy
- Combined EBUS + EUS: highest sensitivity for complete mediastinal staging
- Sarcoidosis: EBUS-TBNA has ~80% diagnostic yield — often avoids surgical biopsy
- Lymphoma: may need core biopsy (not just FNA) for subtyping — consider surgical biopsy
Board High-Yield
Exam Focus- EBUS-TBNA sensitivity for mediastinal malignancy: ~90% — superior to CT/PET
- Cannot sample stations 5, 6 (AP window) — need EUS or mediastinoscopy
- N2 disease on CT/PET: confirm with EBUS before resection (avoid unnecessary surgery)
- EBUS for sarcoidosis: ~80% yield — can avoid VATS in most cases
- ROSE improves diagnostic yield and reduces number of passes needed
ABIM Exam Weight
5%
Interventional Pulmonology represents approximately 5% of the PCCM certification exam.