Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness

Arch Bronconeumol. 2016 Feb;52(2):96-102. doi: 10.1016/j.arbres.2015.08.007. Epub 2015 Nov 10.
[Article in English, Spanish]


Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.

Keywords: Cost-effectiveness; Coste-efectividad; EBUS-TBNA; Ecobroncoscopia; Endobronchial ultrasound; Evidence; Evidencia.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Bronchoscopy*
  • Cost-Benefit Analysis
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / adverse effects
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / economics
  • Humans
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / pathology*
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology*
  • Neoplasm Staging
  • Time Factors