EBUS-TBNA in Hyderabad: Endobronchial Ultrasound Biopsy

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Most people hear the word “EBUS” for the first time after a CT or PET scan shows enlarged lymph nodes in the chest. The report says something like “mediastinal lymphadenopathy”, and the next sentence from the doctor is: “We need a sample.”

That can be frightening. But in most cases, EBUS means you won’t need surgery to get that sample.

The centre of the chest, between the lungs, is called the mediastinum. It contains the windpipe, the main airways, the heart and large blood vessels, and a chain of lymph nodes. Those nodes sit right next to the airways but outside them, so a normal bronchoscope can’t see them.

An EBUS bronchoscope has a small ultrasound probe on its tip. Once it’s in the windpipe, the ultrasound “sees through” the airway wall to the lymph nodes and blood vessels beyond. Guided live by that image, a very fine needle is passed through the airway wall into the node, and cells are drawn out. That’s the “transbronchial needle aspiration” (TBNA).

Several samples are usually taken from one or more nodes. Nothing is cut, and there are no stitches.

In India, the commonest reasons for enlarged chest lymph nodes are tuberculosis and sarcoidosis, followed by cancers such as lymphoma and lung cancer. They can look alike on a CT scan, and each needs completely different treatment. EBUS gets the tissue that tells them apart.

In a study of 322 patients at a tertiary centre in Kerala, published in Lung India in 2022, EBUS-TBNA gave the correct diagnosis in 93% overall. That included 94% of tuberculosis cases and 95% of sarcoidosis cases. The authors concluded that in a TB-endemic country like India, EBUS should be the first test for unexplained enlarged chest lymph nodes.

Lung cancer is now the leading cause of cancer death in India. GLOBOCAN 2024 estimates about 1.13 lakh new cases and nearly 99,000 deaths a year. When lung cancer is suspected, EBUS can often confirm the diagnosis and check whether it has spread to the chest lymph nodes, in a single procedure.

That matters more than ever. The 9th edition of the TNM lung cancer staging system, in use since 1 January 2025, now separates spread to a single mediastinal lymph node station (N2a) from spread to multiple stations (N2b). Which one applies can change the stage and the treatment plan. Systematic sampling of the nodes by EBUS is how this is measured without surgery.

EBUS samples can also be used for the tumour marker tests (such as EGFR, ALK and PD-L1) that decide whether targeted therapy or immunotherapy is an option.

Tumours or cysts lying against the windpipe or main airways can often be sampled with EBUS instead of a CT-guided needle through the chest wall, or surgery.

No. EBUS is a minimally invasive procedure, not an operation. There’s no incision or stitches and no stay in the operation theatre’s recovery ward; most people go home the same day.

Before EBUS became widely available, sampling these lymph nodes usually meant a mediastinoscopy. That’s a surgical procedure under general anaesthesia, through a cut at the base of the neck. EBUS has replaced it as the first choice in most situations.

You’ll be given written instructions. These are the usual steps:

• Before the day: a consultation to review your CT or PET-CT scan and plan which nodes to sample. Blood tests (blood count, clotting), and sometimes an ECG.
• Blood thinners: tell the team if you take aspirin, clopidogrel, warfarin or any newer blood thinner. Some need stopping a few days before; never stop them on your own.
• Diabetes: your diabetes medicines or insulin dose may need adjusting for the fasting period.
• Fasting: nothing to eat for about 6 hours before the procedure. Clear fluids may be allowed until 2 hours before .
• Bring someone with you. After sedation, you shouldn’t drive, ride a two-wheeler, sign important documents, or operate machinery for 24 hours.
• Bring: all scan reports and CDs (especially the PET-CT), your medicine list, and any previous biopsy reports.

• Check-in at Apollo’s day-care unit . A nurse checks your details and places a small cannula in your hand.
• Numbing and sedation. Your throat is sprayed with local anaesthetic. Sedation is given through the cannula, so you’re drowsy and comfortable. Most people remember little or nothing of the procedure .
• Monitoring. Oxygen through a small tube, plus continuous checks of oxygen levels, heart rate and blood pressure.
• The scope. The EBUS bronchoscope is passed through the mouth (via a mouth guard) into the windpipe.
• Ultrasound and sampling. Each lymph node is located on ultrasound, with blood vessels checked using colour Doppler. Then the fine needle samples it, usually several passes per node. In lung cancer staging, nodes are sampled in a set order.
• On-the-spot check (if available). A pathologist may look at the samples during the procedure to confirm enough material has been collected (rapid on-site evaluation, ROSE).
• Finish. The scope is removed. The whole procedure usually takes 30–60 minutes, depending on how many nodes are sampled.

• Observation: you’re monitored for 2–4 hours until the sedation wears off.
• Eating: you can eat and drink once the throat numbness has worn off, usually about 1–2 hours after. Start with a sip of water.
• Common and expected:
• A sore throat
• A hoarse voice
• A cough
• A little blood-streaked sputum for a day or so
• Going home: most people go home the same day with an escort.
• Back to normal: most people return to normal activities the next day.

Call the hospital or seek urgent care if you have:

• Increasing breathlessness
• Chest pain
• Coughing more than a few teaspoons of blood
• A high fever after the first evening

EBUS is considered a safe procedure. Serious complications are uncommon.

• In the 322-patient Indian series above, there were no severe complications. Five patients needed overnight observation because their oxygen levels stayed low; the rest went home after about 2 hours.
• A prospective study published in Cancers in 2023 followed patients for 30 days after endosonography and/or guided bronchoscopy. 2.4% had a severe complication in that period.

Possible risks include:

• Sore throat and cough (common, short-lived)
• Minor bleeding at the needle site
• A temporary fall in oxygen levels during sedation
• Infection, such as fever or pneumonia (uncommon)
• Pneumothorax (air leak around the lung) (rare)
• Reactions to sedation

Your doctor will go through the risks that apply to you, especially if you have heart or lung disease, before you sign the consent form.

Samples go to several labs, so results come back in stages:

You’ll have a results appointment to go through the findings and the plan, at Apollo or at Breathe Well, Kondapur in the evening.

Sometimes EBUS shows only “reactive” lymph node cells, or not enough material. That doesn’t always mean all is well; the next step depends on how strongly the scans pointed to a disease.

What changes the cost:

• Sedation type: general anaesthesia costs more than conscious sedation.
• Number of nodes sampled.
• Lab tests: which tests the samples need.
• Stay: day-care or an overnight stay.

Insurance: EBUS is often covered as a day-care procedure under health insurance policies, subject to policy terms. Apollo’s insurance desk confirms cashless eligibility before the procedure.

EBUS-TBNA at Apollo Hospitals, Financial District is performed by Dr. Kishan Srikanth Juvva .

• Training:
• DM in Pulmonary and Critical Care Medicine
• Master’s in Interventional Pulmonology from the University of Florence, Italy, a programme focused on bronchoscopic and pleural procedures, including EBUS
• Memberships:
• World Association for Bronchology and Interventional Pulmonology (life member)
• Indian Association for Bronchology (life member)
• Research: presented on therapeutic bronchoscopy at the American Association for Bronchology and Interventional Pulmonology (AABIP) conference in Chicago in 2023

about Dr. Kishan

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