According to data from WHO or the World Health Organization, in 2020, lung cancer was the second most common new cancer diagnosis after breast cancer and had the highest mortality rate compared to other types of cancer.
When it comes to thoracic and bronchial procedures, it must be acknowledged that currently, they are widely used in cancer cases. Cancer remains a significant health problem that requires continuous development of new knowledge and innovative treatments. One of these is the EBUS-TBNA examination, which will be discussed below.
What is EBUS-TBNA?
EBUS-TBNA, or Endobronchial Ultrasound Guided Transbronchial Needle Aspiration, is used to effectively diagnose lung cancer from the early stages. It is not only for diagnosing lung cancer but can also diagnose bronchial tumors, tuberculosis, and other respiratory diseases. The procedure involves “the doctor using ultrasound-guided needle aspiration to sample tissue beside the bronchus”. It is a minor surgery that is safe and used to diagnose patients with masses beside the bronchus. The doctor will schedule the patient for bronchoscopy, which involves inserting a small camera through the mouth into the bronchus. The camera is small enough to be placed beside the bronchus and emits ultrasound waves to display images on a computer screen at the suspected area. Then, the doctor uses a small needle to aspirate tissue samples and sends them to a pathologist for laboratory examination.
Advantages of treatment with EBUS-TBNA
In traditional examinations, patients must stay in the hospital and recover for at least 2 weeks. However, EBUS-TBNA reduces risks for patients with underlying conditions who cannot undergo general anesthesia. It also reduces hospital stay and side effects compared to standard methods.
Nevertheless, this procedure may have limitations regarding equipment and personnel, as it must be performed by a pulmonologist with expertise.
What are the limitations of EBUS-TBNA?
Since the EBUS-TBNA camera requires proximity to the bronchus, if a patient has a mass blocking the bronchus so the camera cannot pass through, the examination cannot be performed. For example, if the mass is near the chest wall, a needle biopsy through the chest wall may be necessary instead. Additionally, the effectiveness of EBUS-TBNA ranges from 60%-90%, depending on the patient’s pathology and the expertise of the performing doctor.
Preparation before undergoing EBUS-TBNA
- Patients must see a doctor for a physical examination, disease assessment, and evaluation of readiness for surgery.
- Provide information about underlying diseases and regularly taken medications.
- Blood tests to check hemoglobin levels and blood clotting parameters.
- Fasting from food and water for at least 6 hours before surgery.
- Take regular medications for chronic diseases in the morning before surgery.
- Stop blood-thinning or anticoagulant medications about 5-7 days before surgery.
How to take care of yourself after undergoing EBUS-TBNA
EBUS-TBNA is a minor surgical procedure, so patients can recover immediately after the procedure or within 1 hour. They can then eat and take medications as usual. Patients usually rest and are observed in the hospital for only 1 day, after which they can return to their normal daily activities.
Precautions after the examination
If there is coughing with blood-tinged sputum, avoid forceful coughing. If there is a high fever after returning home or symptoms of shortness of breath or chest tightness, patients can return to see the doctor before the scheduled appointment.
Sharing an interesting patient case experience
The doctor encountered a patient with colon cancer who had undergone surgery and chemotherapy and was cured. The patient consulted about pulmonary tuberculosis and was prescribed tuberculosis medication. After completing 6 months of tuberculosis treatment, a follow-up CT scan showed enlarged lymph nodes beside the bronchus, which was not consistent with tuberculosis symptoms. The doctor performed EBUS-TBNA to biopsy the area, and the pathology results revealed metastatic colon cancer spreading to the area beside the bronchus. This EBUS-TBNA procedure allowed for rapid diagnosis and earlier treatment of the colon cancer.
