title: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): applications in chest disease.
abstract: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive option for staging the mediastinum in suspect lung cancer but also in the diagnosis of mediastinal lesions accessible from the airway. This review is aimed at centres considering establishing an EBUS service that may not be so familiar with the technique. It focuses primarily on technical aspects of EBUS-TBNA, training issues, cost considerations, indications, advantages and disadvantages compared with other mediastinal sampling techniques as well as some reference to its performance in clinical studies. In summary, EBUS-TBNA is primarily used for staging non-small cell lung cancer, especially for bulky mediastinal disease and discrete N2 or N3 disease on CT, but also used for the diagnosis of unexplained mediastinal lymphadenopathy. For radical treatment staging, mediastinoscopy is still used at many centres and negative EBUS-TBNA results should be corroborated by mediastinoscopy. In the future, EBUS-TBNA may be used for staging the radiologically normal mediastinum and in re-staging. It is a procedure that can be taught with ease by an experienced operator, has numerous advantages over mediastinoscopy and is potentially cost saving by reducing the number of mediastinoscopies and associated peri-operative support required.
authors.affiliation: Department of Respiratory Medicine, Allergy and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, Leicestershire, UK. andrewmedford@hotmail.com
authors.forename: Andrew R L
authors.initials: AR
authors.lastname: Medford
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Bennett
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Free
authors.forename: Sanjay
authors.initials: S
authors.lastname: Agrawal
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001999:Bronchoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008481:Mediastinoscopy; D009367:Neoplasm Staging; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000191:economics / Q000379:methods*