Endobronchial Ultrasound (EBUS) guided Transbronchial Needle Aspiration (TBNA) are considered as latest developments in diagnosing chest diseases accurately. EBUS TBNA are regarded as solution to problems of misdiagnosis in case of chest diseases. Dr Vishwanath Gella, interventional pulmonologist at Continental Hospitals, gives a picture about EBUS TBNA in an interview.
Can you explain about EBUS TBNA?
Endobronchial Ultrasound is the latest and accurate equipment for diagnosis of chest diseases. This is a special diagnostic procedure that uses a special type of ultrasonic bronchoscope called EBUS scope which has ultrasound probe at the tip of the bronchoscope. Bronchoscope is an instrument used for visualizing the inside of lungs..
How is EBUS TBNA better ?
Traditionally Blind TBNA (without ultrasound guidance) or CT Guided biopsy or Mediastinoscopy (major surgery done under general anesthesia with a cut in the chest) is performed for diagnosing chest related problems.
EBUS and TBNA are more accurate and precise than Blind TBNA or CT guided biopsy. The real time guidance provided by the ultrasonic bronchoscope helps in visualizing the exact structure to be sampled and avoids complications like injuries to the major blood vessels. A cut in the chest is not required for EBUS procedure. The ultrasound probe at the tip of the bronchoscope helps in visualizing the lesions present in the mediastinum.
What are advantages of EBUS TBNA?
We often see that patients with chest diseases are misdiagnosed due to lack of advanced equipment and expertise. Patients with shadows and enlarged lymph nodes in their chest (lymph gland swellings) are commonly put on a trial of TB medicines without any concrete evidence. As a result, patients with diseases other than TB like lung cancers, infections were misdiagnosed. Due to misdiagnosis the actual problem is found out at an advanced stage. EBUS and TBNA are also helpful in making an accurate diagnosis of drug resistant varieties of TB.
In which cases does EBUS TBNA is useful?
EBUS and TBNA are useful in diagnosing lung cancers, metastatic cancers, lymphoma, sarcoidosis, TB, fungal infections etc.
How are EBUS TBNA performed?
EBUS is a daytime procedure and the patients should not eat or drink for six hours before the procedure. Patients on treatment for high blood pressure should take the drug early in the morning. Before the procedure, nebulization and spray on back of the throat with local anesthetic drug is done to make the throat numb. During the procedure, ultrasonic bronchoscope is passed either through the mouth, along the back of the throat, or through the vocal chords into the major airway (trachea or wind-pipe). The trachea and bronchi are examined with the bronchoscope, and then video and pictures are obtained.