Endobronchial Ultrasound- Transbronchial Needle Aspiration (EBUS-TBNA)

One of the cutting-edge procedures in children is Endobronchial Ultrasound (EBUS) with Transbronchial Needle Aspiration (TBNA). This procedure plays a vital role in diagnosing and managing various respiratory conditions in children, especially those requiring tissue sampling from the lungs or surrounding lymph nodes.

What is Endobronchial Ultrasound with TBNA?

Endobronchial Ultrasound (EBUS) combined with Transbronchial Needle Aspiration (TBNA) is a highly effective, minimally invasive diagnostic technique used to examine the lungs and nearby structures in children. EBUS uses ultrasound imaging to visualize the airways, while TBNA allows the physician to obtain tissue samples from suspicious areas (such as lymph nodes or lung masses). This procedure helps in diagnosing conditions like lung infections, cancers, tuberculosis, and other pulmonary diseases in children.

How is EBUS with TBNA performed in children?

In children, the procedure is typically performed under mild sedation or anesthesia for the child’s comfort. A flexible bronchoscope is inserted through the nose or mouth, and an ultrasound probe attached to the bronchoscope is used to get detailed images of the lungs and surrounding structures. The lymph node or mass is lovated using ulrasound and a needle is passed through the bronchial wall to obtain tissue samples. The collected samples can be analyzed for conditions like tuberculosis, cancer, or infection.

Why is EBUS-TBNA important for children?

EBUS-TBNA is a minimally invasive procedure for obtaining tissue samples and relatively safe with minimal recovery time. It is a good alternative to surgical biopsy as we can reach deeper structures in the chest without the need of open surgery. Some of the indications of EBUS-TBNA are listed below

Diagnosis of Pulmonary Infections

EBUS-TBNA is particularly valuable in diagnosing tuberculosis (TB) and other chronic respiratory infections. In children, TB can present with vague symptoms, making early and accurate diagnosis difficult. EBUS-TBNA allows for direct sampling of infected lymph nodes or lung tissue to confirm TB and initiate appropriate treatment early, helping prevent complications.

Evaluation of Mediastinal and Hilar Lymphadenopathy

Enlarged lymph nodes in the chest (mediastinum and hilum) are common findings in children with respiratory diseases. EBUS-TBNA enables precise sampling of these lymph nodes to diagnose conditions like infections, lymphoma, and sarcoidosis. It helps determine whether the enlargement is due to benign or malignant causes, aiding in the staging of diseases such as cancer.

Lung Cancer and Tumor Detection

Though rare in children, lung cancer and other pulmonary tumors can occur. EBUS-TBNA offers an effective way to sample tumor tissue from the lungs or nearby structures for diagnosis. The ability to biopsy tumors with minimal discomfort is essential in pediatric cases, where more invasive procedures may not be appropriate.

Assessment of Chronic Respiratory Disorders

Children with chronic respiratory issues like persistent cough, wheezing, or recurrent pneumonia can benefit from EBUS-TBNA when standard diagnostic tests do not provide conclusive results. It helps in diagnosing conditions like lymphoid hyperplasia, granulomatous diseases, or autoimmune conditions affecting the lungs.

Frequently Asked Questions

Can EBUS with FNAC be used alongside flexible bronchoscopy?

Yes, EBUS with FNAC can be performed alongside flexible bronchoscopy to directly visualize the airways and obtain tissue samples from deeper lung structures or surrounding lymph nodes, providing a comprehensive diagnostic approach.

Is the EBUS with FNAC procedure safe for my child?

Yes, the procedure is safe for children when performed by experienced pediatric pulmonologists. It is minimally invasive, performed under sedation, and has low associated risks.

How long does the EBUS-TBNA procedure take?

EBUS-TBNA is a daycare procedure. The procedure takes around 30 minutes including sedation, and recovery time after procedure is around 1 hour. After recovery from anaesthesia the child is fed under supervision and then sent home.

How soon can we get the results of EBUS-TBNA procedure?

The procedure results are explained to the patient immediately after the procedure and the report is handed over at discharge. The result of tissue biopsy and FNAC takes around 3-5 days.

5. In which conditions EBUS-TBNA is required?

Condition in which lymph nodes in the chest are enlarged or a mediastinal mass is present, tissue sampling maybe required for diagnosis and EBUS-TBNA is the best procedure for that. Some of the conditions that can lead to enlarged mediastinal lymph nodes are tuberculosis, sarcoidosis, lymphomas, fungal infections.