Radial EBUS TBNA

This chapter focuses on Radial Endobronchial Ultrasound (EBUS), an advanced technique for accessing and sampling peripheral pulmonary lesions and mediastinal structures. It outlines the principles and advantages of radial EBUS, which provides circumferential ultrasound imaging to guide TBNA, enabling accurate targeting of lesions that are not easily accessible through conventional bronchoscopy. The chapter covers the indications for using radial EBUS-TBNA, such as the evaluation of lung tumors, staging of cancers, and the diagnosis of infectious or inflammatory conditions. It also addresses the procedural techniques, including optimal positioning, needle insertion, and specimen collection, as well as the potential complications and strategies for overcoming challenges. By offering practical insights and clinical tips, this chapter serves as a valuable resource for healthcare professionals seeking to enhance their skills in performing radial EBUS-TBNA, improving diagnostic yield and patient care. EBUS with radial scanning miniature probe are nowadays used frequently owing to its minimal complications. The smaller diameter and high resolution of image allows it to be used for various indications. Some of the endobronchial tumors which are invisible on radiology can be detected and their extent as well as size, relationship with their surrounding structures can be well delineated by EBUS. This is helpful for patients who are at risk or have sputum cytology positive without radiological features. In situ lung cancer which are limited to the mucosa and not transgressing the lamina propria, as well as early lung cancer confined to the inner layers of the bronchial wall without infiltration to the cartilage can be detected by autofluorescence and narrow band imaging bronchoscopy procedures. It can also be detected with better precision by radial EBUS where alterations in the texture of the bronchial wall can be detected by using a 20 MHz radial probe (Fig. 7.1).