Upcoming endoscopic techniques: Endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively new, safe, minimally invasive mediastinal staging and sampling technique. It performs as well as mediastinoscopy in sensitivity (and is superior to conventional transbronchial needle aspiration (TBNA) although a negative EBUS-TBNA result should still be followed by mediastinoscopy in those where malignancy is strongly suspected. It is also safer than mediastinoscopy and conventional TBNA. More recent data suggest combined endosonography (EBUS-TBNA and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)) is superior in performance to mediastinoscopy alone. EBUS-TBNA also has an important role in the diagnosis of unexplained malignant and benign mediastinal lymphadenopathy including extrathoracic malignancy, sarcoidosis, tuberculosis and even lymphoproliferative disease. EBUS-TBNA may also have a future expanding role in the assessment of airway disease and pulmonary vascular disease. Expansion of EBUS-TBNA is likely to be limited by the required training (although there is a need for standardised national recommendations) and costs. In the longer term, however, this technique should be cost saving by avoiding unnecessary other sampling techniques. In the short term, conventional TBNA is a useful technique in the absence of EBUS-TBNA. Further studies are in progress to determine whether it will also speed up time to diagnosis and treatment. Combined endosonography is likely to be the most desirable long-term service.