Endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS), over the past decade, they have largely replaced surgical procedures as the first-line approach for mediastinal tissue sampling, as recommended by major international guidelines.
EBUS, performed via the airway, allows real-time ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. It provides high diagnostic accuracy comparable to mediastinoscopy, while being minimally invasive and safer for patients. Importantly, EBUS enables sampling of lymph nodes that may appear normal in size on CT, addressing the limitations of size-based imaging criteria.
EUS, performed through the esophagus, complements EBUS by accessing lymph node stations that are difficult or impossible to reach bronchoscopically, such as the lower mediastinum and the aorto-pulmonary window. EUS is often better tolerated by patients and adds diagnostic value in selected cases, including assessment of the left adrenal gland and infradiaphragmatic metastases.
When used together, EUS and EBUS provide a comprehensive, minimally invasive approach, enabling biopsy of nearly all mediastinal lymph node stations. Clinical evidence consistently shows that combined endosonography improves diagnostic yield, reduces the need for surgical staging, and supports accurate treatment decisions in lung cancer, sarcoidosis, lymphoma, and other mediastinal diseases.
Beyond diagnosis, the advanced sample handling technonical now allow immunohistochemistry, molecular testing, and genotyping from EUS- and EBUS-guided biopsies-essential for modern, personalized lung cancer therapy.
In today's clinical workflow, EUS and EBUS are becoming essential components of evidence-based mediastinal evaluation-offering precision, safety, and efficiency for both patients and clinicians.
