Endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA
Endobronchial ultrasound guided transbronchial needle aspiration, also commonly called EBUS-TBNA is a common interventional pulmonology procedure which is carried out to make a diagnosis of enlarged lymph nodes or lymphadenopathy inside the chest or the mediastinum.
What is a transbronchial needle aspiration or TBNA?
Transbronchial needle aspiration or TBNA is a procedure used to obtain cellular material or samples from the lymph nodes inside the chest adjacent to the airway by passing a needle through the bronchial wall. The material obtained is sent for detailed analysis and helps in diagnosis of various disorders.
What is an endobronchial ultrasound or EBUS?
The endobronchial ultrasound or EBUS bronchoscope is a flexible bronchoscope with an ultrasound transducer attached at the distal end. During bronchoscopy the pulmonologist can directly observe the airway and in addition can use the ultrasound to examine the various lymph node stations adjacent to the airways. The endobronchial ultrasound or EBUS hence allows a pulmonologist to visualise the lymph node stations in real time. With the ultrasound guidance various procedures can be done from the lymph nodes such as fine needle aspiration or FNAC under direct vision. This makes the procedure easier to perform, makes it safer for the patient and increases the chances of yield from the samples which are obtained.
What are the conditions where an endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA is required in children?
There are many conditions where the lymph nodes can be increased in size inside the chest of the child. These conditions could be tuberculosis, lymphoma, sarcoidosis, etc. There could be situations where it is unclear whether tuberculosis is Multi drug resistant or MDR. These are situations where a sample needs to be obtained from the lymph nodes. Endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA is extremely useful in such situations to make a proper diagnosis.
How is an endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA performed?
After giving sedation and local anaesthesia the endobronchial ultrasound or EBUS bronchoscope is introduced through the mouth of the child. Once the voice box and vocal cords are identified the EBUS bronchoscope is advanced into the windpipe or the trachea of the child. This is followed by a systematic examination of the airway and the various lymph nodes are identified with the help of the endobronchial ultrasound.
Once the lymph node stations are identified, a sample is taken from the lymph nodes by a fine needle aspiration or FNA. During the procedure of fine needle aspiration, under the continuous guidance of the ultrasound a small needle is passed through the channel of the bronchoscope into the lymph node and a small sample is taken.
The sample is then sent to the laboratory for a detailed evaluation. These tests include: cytological examination, various tests for tuberculosis, cultures and other microbiological investigations.
Is the endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA procedure done under sedation for general anaesthesia?
The endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA is performed under sedation and local anaesthesia in the bronchoscopy suite. Sedation and local anaesthesia helps to reduce or minimize any discomfort and pain during the procedure.
How much time does it take to perform an endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA?
It takes approximately 20 to 30 minutes to complete the procedure.
Are there any complications of an endobronchial ultrasound guided transbronchial needle aspiration or EBUS-TBNA?
There are no significant complications of this procedure. There can be a very minimal amount of bleeding, which can happen. This can easily be controlled.