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 ​local anaesthetic​ with ​sedation​ . Or you might have a ​general anaesthetic​ .

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 ​stage​ 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 ​anaesthetist​ 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.

More information

You can read more information about other tests to help doctors diagnose lung cancer.

Tests for lung cancer