Endobronchial Ultrasonography (EBUS)

Lung cancer, for which rapid diagnosis at an early stage is very important for long lifespan, is one of the most common cancers in our country and in the world. Despite the importance of early diagnosis, many smokers may see a doctor late, attributing complaints such as phlegm and cough to smoking. Scans are very important because it is recommended that people over the age of 55, who have smoked a pack of cigarettes every day for 20 years, have at least one low-dose lung tomography scan, even if they have no symptoms. Because it is important to detect lung cancer at an early stage and start treatments accordingly without wasting time. One of the most important methods used in the diagnosis of lung cancer is endobronchial ultrasonography (EBUS).

Endobronchial Ultrasonography in the Diagnosis of Lung Cancer

There are many methods used today in the diagnosis of lung cancer. The most commonly used one is “flexible bronchoscopy”, in which the airways in the lungs are visualized and biopsied with a flexible, thin and lighted tube. In some patients, a biopsy can be performed from the outside, that is, from the chest wall, using a needle and tomography guidance, while in some patients, biopsies can be performed under ultrasonography guidance. However, the subject of our article is endobronchial ultrasonography (EBUS), which allows faster diagnosis and is used in some centers although it is not very common in Turkey.

Why is the method to be used in diagnosis important? What is the difference and advantages of EBUS?

Among the diagnostic methods, it becomes very important for the patient to decide which one to use. When deciding which diagnostic method to choose, the success rate of the method in diagnosis and the low risk of complications are two very important factors. Choosing the most accurate diagnostic method according to the stage of the disease and the general characteristics of the tumor is of vital importance in terms of making the diagnosis as soon as possible. Another critical point is that the expert who will make and implement the decision should be experienced. In this process, it is important to evaluate minimum side effects and minimum risks in order to avoid losing valuable time for the patient.

After diagnosis by bronchoscopy or tomography-guided biopsy, staging, that is, determination of the extent of the cancer, is needed before starting the treatment of lung cancer. Therefore, in order to sample the mediastinal lymph nodes affected by cancer, if endobronchial ultrasonography is not possible, mediastinoscopy is performed under general anesthesia. Mediastinoscopy is a procedure performed by entering the neck area to take samples from the lymph nodes, but it is not a recommended procedure due to the risks of complications. In addition, the complication risks of mediastinoscopy are much higher than endobronchial ultrasonography and can only be performed once on a patient. In other words, the mediastinoscopy procedure is very difficult to repeat; However, EBUS can be easily applied to a patient again. When evaluated in terms of cost, EBUS is a more cost-effective method than mediastinoscopy. If conditions are possible, the first diagnosis and staging method to be recommended is endobronchial ultrasonography. Its important advantages are that it has lower complication risks and that it provides diagnosis and staging at the same time, in a single session. For example, if a patient has a tumor in the outer part of the lung, its size is less than 3 cm, and there is no tumor spread to another organ, which we call distant metastasis, the treatment recommended for that patient will be surgery without further diagnostic procedure. However, if the tumor is larger in size and is centrally located, EBUS is recommended. Additionally, EBUS sampling is required in patients with pathological mediastinal lymph nodes detected by lung computed tomography or positron emission tomography/computed tomography (PET/CT).

How to do EBUS?

EBUS, which is performed through the mouth under general anesthesia for the comfort of the patient, is an imaging method obtained by combining bronchoscopy and ultrasonography. In this method, which is based on taking a sample piece through the mouth with a camera and a small needle coming out of the tip of the device, mediastinal lymph nodes or sometimes a mass lesion, not the bronchi, are imaged and a piece is taken for examination. The method also has a Doppler ultrasonography feature. While imaging the lymph nodes, it also images the vessels near them, preventing damage to the vascular structures. While the diagnosis and subsequent staging processes with the bronchoscopy method can take more than 30 days, the diagnosis and staging of the disease with the EBUS method only takes 2 days. In fact, in our hospital, with the method of rapid examination of biopsy samples taken while the procedure is ongoing (ROSE, rapid on-site examination), the biopsy result is learned as soon as the procedure is completed.

Who Can Have EBUS?

We can say that EBUS is used in the diagnosis and staging of lung cancer, as well as in the diagnosis of diseases such as lymphoma and tuberculosis, especially those affecting the lymph nodes. It is also used for biopsy of lung lesions in addition to biopsy of lymph nodes. It is also a method used in the investigation of metastases due to cancers other than lung cancer, in cases where repeat biopsy is required for advanced genetic examinations in patients with advanced stage lung cancer and who do not respond to chemotherapy, and in determining the recurrence of lung cancer. Of course, it is not correct to say “it applies to every patient”; It is not recommended for use in patients who have had a heart attack in the last four weeks, patients with bleeding disorders, patients with respiratory failure and patients receiving long-term oxygen support.

The branch of pulmonology that diagnoses lung cancer is replaced by medical oncology, radiation oncology and surgery branches during the treatment process. At Anadolu Health Center, patients are evaluated in tumor boards with wide participation, in accordance with international standards, with the common view of all relevant branches. While surgical treatments are generally applied to lung cancer patients up to stage 3, radiation oncology treatments can be given when there are other accompanying diseases. For stage 3 patients, the patient is evaluated surgically after chemotherapy. For patients with stage 4 cancer, combined treatments (chemotherapy and/or radiotherapy) are applied with all these options.

How Long Does EBUS Last?

The duration of EBUS varies depending on whether the procedure is performed under general or local anesthesia. However, the procedure takes approximately 20-30 minutes and once completed, the patient can return home the same day.

One in every 10 smokers gets lung cancer. But what is even more striking is this: One in two smokers die from smoking-related diseases. Unfortunately, cancers such as laryngeal, esophagus, stomach, bladder cancer and cardiovascular diseases are unfortunately increasing due to smoking. Therefore, we recommend everyone who smokes to quit smoking.

According to a study, while the incidence of lung cancer has decreased relatively slightly in men in recent years, it has increased in women due to the increase in smoking.

Lung cancer is the most common type of cancer in men. In women, it is the second most common type of cancer after breast cancer.