Endobronchial ultrasound (EBUS)
Endobronchial ultrasound is also called Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA). It is a test that can show if:
- an abnormal looking area is cancer
- the size of the cancer
- the cancer has spread into other lung areas or outside the lung
This test uses a narrow flexible tube called a bronchoscope to look at the inside of the breathing tubes (airways) in your lungs. The bronchoscope has an ultrasound probe. It uses high frequency sound waves to create pictures of the lungs and structures outside the airway walls, such as the lymph nodes.
Your doctor can see any areas that look abnormal and take samples (biopsies) to test.
You normally have this test in the endoscopy unit at the hospital. It can take up to 1 hour, but you should expect to be in hospital for a few hours.
You have the test under a 
with . Or you might have a .
Why do I need an EBUS-TBNA?
You might have this test after an x-ray or CT scan if your doctor has seen:
- an abnormal looking area on your lung
- enlarged
lymph nodes
This test can help your doctor diagnose and lung cancer and mesothelioma.
What do I need to do to prepare for an EBUS-TBNA?
You usually have written information explaining how to prepare for your EBUS-TBNA. It’s important that you read and follow the instructions. There is usually a number to call if you have any questions.
You might have blood tests beforehand to check your blood levels and how well your blood clots.
Tell your doctor if you're taking medicines that changes how your blood clots. This includes:
- warfarin or heparin
- aspirin
- clopidogrel
- apixaban or rivaroxaban
- ticagrelor
Your doctor will tell you if you need to stop taking these or any other medicines for a while before your EBUS-TBNA.
You can't eat or drink for some time before the test. The instructions may be different depending on the hospital where you have your test. Check your letter to find out when you need to stop eating and drinking. Contact the department in advance if this is a problem for you, for example, if you have diabetes.
I'm having a general anaesthetic
This means you will be asleep and won't feel anything during the test.
You meet the before your test. They look after you while you have the anaesthetic and while the chest doctor is carrying out your EBUS-TBNA. The anaesthetist might give you some painkillers to prevent soreness.
What happens on the day?
Before the test
When you arrive at the endoscopy department the nurse takes some measurements. This includes your blood pressure, heart and breathing rate, your oxygen level and weight.
A doctor or nurse will explain the procedure and ask you to sign a consent form. This is a good time to ask any questions you may have.
You may need to change into a hospital gown, or you might be able to stay in your own clothes. If you have false teeth you may need to remove them for the test.
If you’re having a local anaesthetic with or without a light sedation
The nurse takes you to the test room. You may have the test sitting upright on the procedure couch or lying down. The nurse will explain what position they want you in.
You might have a sedative. This will help you to relax and can make you feel sleepy, but you will be able to answer questions. You have the sedative through a small tube into your vein (cannula).
The doctor will numb your nose and throat using a local anaesthetic. They will either use a spray or a spray and gel. This can make you cough; your eyes may water and you may have a bitter taste in your mouth. You may feel like you can't swallow but you can.
The nurse or doctor also places a nose or mouthguard in the area the bronchoscope will travel down.
You may have oxygen through a small plastic tube or sponge that sit just inside your nostril. They also put a clip on your finger to check your oxygen levels and heart rate.
If you are having a general anaesthetic
The nurse will take you to the room and you lie on a couch. The anaesthetist puts a cannula in one of your arms. You then have the anaesthetic drug through the cannula into your bloodstream.
During the test
Your doctor puts the bronchoscope into your mouth or down a nostril to your airways. This is a bit uncomfortable but it doesn't last long. It shouldn’t hurt because you have had the local anaesthetic. You can breathe normally.
Your doctor can see the images from the bronchoscope on a television screen. They look for anything abnormal and take tissue samples (biopsies) to test. Or they might take some cells by using a small brush or using a liquid to collect them. They can also take photographs of the inside of your airways.
After the test
Afterwards, you'll feel sleepy. A nurse will monitor you in the recovery area until you are fully awake and recovered.
You won’t be able to eat or drink anything until the local anaesthetic wears off. This usually takes an hour or two. This is because your throat is too numb to swallow safely at first.
The nurse will remove the cannula before you are ready to leave.
Your doctor will talk to you about how the test went. They will tell you if they took any biopsies and when to expect the results.
Going home
You can usually go home the same day. If you take blood thinners your doctor or nurse will tell you when to restart them. This is usually the next day. Someone should collect you from the hospital and stay with you overnight if you have had a sedative or anaesthetic.
For 24 hours after having sedation or an anaesthetic, you shouldn't:
- drive
- drink alcohol
- operate heavy machinery
- sign any important documents
You need to take things easy for a day or so. You might have a sore throat or hoarse voice for a couple of days.
Possible risks of EBUS-TBNA
An EBUS-TBNA is a very safe procedure. Your nurse will tell you who to contact if you have any problems afterwards. Your doctors will make sure the benefits of having an EBUS-TBNA outweigh these possible risks.
The possible risks include:
Bleeding
You might see a small amount of blood in your spit after the test. Let your doctor or nurse know if this doesn’t go away.
Chest infection
See your GP straight away if your phlegm (sputum) changes colour, you start feeling more breathless or you feel as though you have a temperature.
Needing extra oxygen
You might need oxygen through a mask for some time after the bronchoscopy. If you normally have oxygen at home you might need to have more than usual for a little while.
A collapsed lung (pneumothorax)
Air or gas can collect in the space around the lung and make it collapse, but this is rare. Contact your doctor or go to Accident and Emergency (A&E) if you become short of breath or have chest pain. You have a tube put into the lung to remove the air.
Inflammation or infection of the central part of the chest (mediastinitis)
Inflammation or infection of the central part of the chest (mediastinum) can happen. Symptoms include pain or discomfort in the centre of your chest. Contact your healthcare team or go to A&E if you have this. You will need to be admitted to hospital for treatment with antibiotics into a vein (intravenously).
Getting your results
You should get your results within 1 or 2 weeks. Contact your doctor if you haven’t heard anything after this time.
Waiting for test results or for further tests can be very worrying. You might have contact details for a specialist nurse and you can contact them for information if you need to. It may help to talk to a close friend or relative about how you feel.
More information
You can read more information about other tests to help doctors diagnose lung cancer.
