Centre of Excellence for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA)
Overview
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, advanced bronchoscopic procedure that combines real-time ultrasound imaging with a bronchoscope to visualize and sample mediastinal and hilar lymph nodes, as well as lung masses adjacent to the airways. This technique has revolutionized the diagnosis and staging of thoracic diseases, particularly lung cancer, sarcoidosis, and tuberculosis. Dr Prashant Chhajed currently leads the Chhajed Lung Care and Sleep Centre in Mumbai has contributed to the development of EBUS TBNA and the initial publications during his stay in Japan in 2002. Dr Prashant Chhajed was the first to introduce EBUS TBNA in Mumbai and Western India in 2010 and the second in India.
What are mediastinal & hilar lymph nodes?
Mediastinal and hilar lymph nodes are key components of the body’s lymphatic system, located in the central chest (mediastinum) and around the lung hila. These nodes are critical for immune surveillance and are commonly involved in various diseases, including infections, inflammatory conditions, and cancers.
Indications for EBUS-TBNA
- Investigating enlarged lymph nodes in the chest.
- Diagnosing and staging lung cancer, especially non-small cell lung carcinoma (NSCLC).
- Diagnosing benign conditions such as sarcoidosis and tuberculosis.
- Evaluating unexplained mediastinal or hilar lymph node enlargement
- Acquiring samples for molecular testing of lung cancer such as ALK, EGFR, KRAS, NGS (New Generation Sequencing)enlarged lymph nodes in the chest.
How Is EBUS-TBNA Performed?
Real-time ultrasound allows precise visualization of lymph nodes and masses beyond the airway wall.
A fine needle is introduced through the bronchoscope to sample the targeted lymph nodes or lesions under direct ultrasound guidance.
Safety and Diagnostic Yield
- EBUS-TBNA is well-tolerated, with a very low complication rate, making it safer than surgical alternatives such as mediastinoscopy.
- For lung cancer staging, EBUS-TBNA provides sensitivity equivalent to mediastinoscopy, with the added benefit of accessing hilar nodes and avoiding general anesthesia.
- In tuberculosis, EBUS-TBNA enables rapid microbiological diagnosis, including drug-resistant TB, through molecular and culture-based methods. This paper was published by Dr Prashant Chhajed in the ERJ Open in 2019.
- For sarcoidosis, EBUS-TBNA demonstrates high specificity and good sensitivity, with similar diagnostic yields for both hilar and mediastinal lymph node sampling.
Advantages of EBUS-TBNA
- Minimally invasive with rapid recovery.
- Real-time imaging ensures accurate targeting and sampling.
- Reduces the need for more invasive surgical procedures.
- Suitable for patients with a broad range of thoracic diseases.
Recent Advances and Publications
In Summary
EBUS-TBNA is the current gold standard for minimally invasive sampling of mediastinal and hilar lymph nodes, offering high diagnostic accuracy, safety, and rapid recovery for patients with thoracic diseases such as lung cancer, tuberculosis, and sarcoidosis.
Publications by Dr. Prashant Chhajed Related to EBUS-TBNA
2019 July; 26(3): 199-209 – Click for abstract