Endobronchial ultrasound: Indications, contraindications, and complications
- Kazuhiro Yasufuku, MD, PhD
Kazuhiro Yasufuku, MD, PhD
- Associate Professor of Surgery
- University of Toronto
Endobronchial ultrasound (EBUS) is a bronchoscopic technique that uses ultrasound to visualize structures within the airway wall, lung, and mediastinum [1-3]. EBUS is different from endoscopic ultrasound (EUS). While both can visualize and guide sampling of mediastinal lymph nodes, EBUS is performed during bronchoscopy and EUS is performed during gastrointestinal endoscopy.
The indications, contraindications, and complications of EBUS are discussed in this topic review. Types of EBUS, technical aspects of EBUS-guided sampling, and indications for EUS are described separately. (See "Endobronchial ultrasound: Technical aspects" and "Endoscopic ultrasound-guided fine-needle aspiration biopsy in the gastrointestinal tract".)
There are two types of EBUS:
●Radial probe EBUS (RP-EBUS)
●Convex probe EBUS (CP-EBUS)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hürter T, Hanrath P. Endobronchial sonography: feasibility and preliminary results. Thorax 1992; 47:565.
- Kurimoto N, Murayama M, Yoshioka S, et al. Assessment of usefulness of endobronchial ultrasonography in determination of depth of tracheobronchial tumor invasion. Chest 1999; 115:1500.
- Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005; 50:347.
- Fujiwara T, Yasufuku K, Nakajima T, et al. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest 2010; 138:641.
- Edey AJ, Pollentine A, Doody C, Medford AR. Differentiating benign from malignant mediastinal lymph nodes visible at EBUS using grey-scale textural analysis. Respirology 2015; 20:453.
- Chandra S, Nehra M, Agarwal D, Mohan A. Diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle biopsy in mediastinal lymphadenopathy: a systematic review and meta-analysis. Respir Care 2012; 57:384.
- Nakajima T, Shingyouji M, Nishimura H, et al. New endobronchial ultrasound imaging for differentiating metastatic site within a mediastinal lymph node. J Thorac Oncol 2009; 4:1289.
- Tagaya R, Kurimoto N, Osada H, Kobayashi A. Automatic objective diagnosis of lymph nodal disease by B-mode images from convex-type echobronchoscopy. Chest 2008; 133:137.
- Kurimoto N, Miyazawa T, Okimasa S, et al. Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest 2004; 126:959.
- Herth FJ, Eberhardt R, Becker HD, Ernst A. Endobronchial ultrasound-guided transbronchial lung biopsy in fluoroscopically invisible solitary pulmonary nodules: a prospective trial. Chest 2006; 129:147.
- Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011; 37:902.
- Yoshikawa M, Sukoh N, Yamazaki K, et al. Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without X-ray fluoroscopy. Chest 2007; 131:1788.
- Dooms CA, Verbeken EK, Becker HD, et al. Endobronchial ultrasonography in bronchoscopic occult pulmonary lesions. J Thorac Oncol 2007; 2:121.
- Ost DE, Ernst A, Lei X, et al. Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med 2016; 193:68.
- Kurimoto N, Murayama M, Yoshioka S, Nishisaka T. Analysis of the internal structure of peripheral pulmonary lesions using endobronchial ultrasonography. Chest 2002; 122:1887.
- Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest 2004; 126:122.
- Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax 2003; 58:1083.
- Herth F, Becker HD, LoCicero J 3rd, Ernst A. Endobronchial ultrasound in therapeutic bronchoscopy. Eur Respir J 2002; 20:118.
- Miyazu Y, Miyazawa T, Kurimoto N, et al. Endobronchial ultrasonography in the assessment of centrally located early-stage lung cancer before photodynamic therapy. Am J Respir Crit Care Med 2002; 165:832.
- Harley DP, Krimsky WS, Sarkar S, et al. Fiducial marker placement using endobronchial ultrasound and navigational bronchoscopy for stereotactic radiosurgery: an alternative strategy. Ann Thorac Surg 2010; 89:368.
- Shibuya K, Fujisawa T, Hoshino H, et al. Fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy. Lung Cancer 2001; 32:19.
- Chiyo M, Shibuya K, Hoshino H, et al. Effective detection of bronchial preinvasive lesions by a new autofluorescence imaging bronchovideoscope system. Lung Cancer 2005; 48:307.
- Chhajed PN, Shibuya K, Hoshino H, et al. A comparison of video and autofluorescence bronchoscopy in patients at high risk of lung cancer. Eur Respir J 2005; 25:951.
- Shibuya K, Hoshino H, Chiyo M, et al. Subepithelial vascular patterns in bronchial dysplasias using a high magnification bronchovideoscope. Thorax 2002; 57:902.
- Shibuya K, Hoshino H, Chiyo M, et al. High magnification bronchovideoscopy combined with narrow band imaging could detect capillary loops of angiogenic squamous dysplasia in heavy smokers at high risk for lung cancer. Thorax 2003; 58:989.
- Tanaka F, Muro K, Yamasaki S, et al. Evaluation of tracheo-bronchial wall invasion using transbronchial ultrasonography (TBUS). Eur J Cardiothorac Surg 2000; 17:570.
- Herth F, Ernst A, Schulz M, Becker H. Endobronchial ultrasound reliably differentiates between airway infiltration and compression by tumor. Chest 2003; 123:458.
- Herth FJ, Becker HD, LoCicero J, et al. Endobronchial ultrasound improves classification of suspicious lesions detected by autofluorescence bronchoscopy. J Bronchol 2003; 10:249.
- Sanz-Santos J, Andreo F, García-Olivé I, et al. Diagnosis of acute pulmonary embolism by endobronchial ultrasound as an incidental finding. Respiration 2011; 81:150.
- Cetinkaya E, Yılmaz A, Özgül A, et al. Left atrial mass demonstrated during endobronchial ultrasound session. Respiration 2011; 81:57.
- Casal RF, Jimenez CA, Mehran RJ, et al. Infected mediastinal bronchogenic cyst successfully treated by endobronchial ultrasound-guided fine-needle aspiration. Ann Thorac Surg 2010; 90:e52.
- Steinfort DP, Irving LB. Endobronchial ultrasound staging of thyroid lesion in small cell lung carcinoma. Thorac Cardiovasc Surg 2010; 58:128.
- Senturk A, Er M, Karalezli A, et al. A case of pulmonary artery hydatid cyst observed on endobronchial ultrasound. Iran J Radiol 2015; 12:e15995.
- Mahajan AK, Ibrahim O, Shostak E, et al. EBUS-TBNA of pulmonary artery clot. J Bronchology Interv Pulmonol 2014; 21:371.
- Rey D, Labarca G, Caviedes I, Fernandez-Bussy S. Intracardiac metastasis of lung adenocarcinoma diagnosed by convex-probe EBUS. BMJ Case Rep 2014; 2014.
- Murgu S, Kurimoto N, Colt H. Endobronchial ultrasound morphology of expiratory central airway collapse. Respirology 2008; 13:315.
- Miyazu Y, Miyazawa T, Kurimoto N, et al. Endobronchial ultrasonography in the diagnosis and treatment of relapsing polychondritis with tracheobronchial malacia. Chest 2003; 124:2393.
- Lee P, Low SY, Liew HL, et al. Endobronchial ultrasound for detection of tracheomalacia from chronic compression by vascular ring. Respirology 2007; 12:299.
- Soja J, Grzanka P, Sladek K, et al. The use of endobronchial ultrasonography in assessment of bronchial wall remodeling in patients with asthma. Chest 2009; 136:797.
- Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J 2009; 33:1156.
- Kikuchi E, Yamazaki K, Sukoh N, et al. Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions. Eur Respir J 2004; 24:533.
- Haas AR. Infectious complications from full extension endobronchial ultrasound transbronchial needle aspiration. Eur Respir J 2009; 33:935.
- Parker KL, Bizekis CS, Zervos MD. Severe mediastinal infection with abscess formation after endobronchial ultrasound-guided transbrochial needle aspiration. Ann Thorac Surg 2010; 89:1271.
- Sánchez-Font A, Álvarez L, Ledesma G, Curull V. Localized Subcarinal Adenitis following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Respiration 2015; 90:329.
- Asano F, Aoe M, Ohsaki Y, et al. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013; 14:50.
- Chen A, Chenna P, Loiselle A, et al. Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience. Ann Am Thorac Soc 2014; 11:578.
- Hayama M, Izumo T, Matsumoto Y, et al. Complications with Endobronchial Ultrasound with a Guide Sheath for the Diagnosis of Peripheral Pulmonary Lesions. Respiration 2015; 90:129.
- Wong J, Gutierrez C, Shannon VR, et al. Bronchomediastinal Fistula after Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. Am J Respir Crit Care Med 2016; 194:114.
- Stather DR, Chee A, MacEachern P, et al. Endobronchial ultrasound learning curve in interventional pulmonary fellows. Respirology 2015; 20:333.
- Bellinger CR, Chatterjee AB, Adair N, et al. Training in and experience with endobronchial ultrasound. Respiration 2014; 88:478.
- Cordovilla R, Torracchi AM, García-Macías MC. Enhancement of conventional TBNA outcome after EBUS Training. J Bronchology Interv Pulmonol 2014; 21:322.
- Diagnosis and staging of non-small cell lung cancer
- Mediastinal lymphadenopathy of unclear etiology
- Sampling parenchymal pulmonary nodules
- Sampling endobronchial or peribronchial lesions
- Sampling mediastinal masses
- Guidance of therapeutic procedures
- Detection of early airway malignancy
- Extent of airway tumor invasion
- SUMMARY AND RECOMMENDATIONS