Recent advances in convex probe endobronchial ultrasound: a narrative review

Abstract

Convex probe endobronchial ultrasound (CP-EBUS) has been widely used in the lymph node staging and restaging of lung tumors and the diagnosis of mediastinal diseases. Recent years have seen continuous progress in this technology. For diagnosis, elastography technology can preliminarily distinguish between benign and malignant lesions, so that reduce the number of punctures. CP-EBUS can also be used as an endoscopic ultrasound (EUS) to guide needle aspirations of liver lesions, retroperitoneal lymph nodes and left adrenal gland (LAG) lesions sometimes. Some advances help diagnosing more accurately and effectively, such as the intranodal forceps biopsy (IFB), the new type of 22G needle, the rapid on-site evaluation (ROSE) and the cancer gene methylation, etc. In addition, special advances are being made in diagnosis using artificial intelligence (AI). For treatment, CP-EBUS has yielded novel research results when applied to transbronchial needle injection (TBNI) and radioactive seed implantation in clinical cases, and blocking of the cardiac plexus in animal studies. The next-generation CP-EBUS is also ready for use in the clinic and the technology will be improving continuously. Through this review, we hope to educate clinicians on the latest uses of CP-EBUS and open up further research ideas for readers interested in this technology.

The Diagnostic and Prognostic Value of EBUS‐TBNA for Intrathoracic Metastasis in Previously Treated Patients With Head and Neck Cancer

“…24,25 Current indications for EBUS-TBNA include diagnosis and staging of pulmonary malignancy, intrapulmonary and mediastinal masses, and unknown mediastinal and/or hilar lymphadenopathy. 26 Compared with minimally invasive surgical approaches, the advantages of an EBUS-TBNA procedure comprise reduced trauma, blood loss, operation time, medical expenses, and real-time elastography-targeted biopsy for thoracic tumors. 7,14,23 A multicenter randomized controlled trial on the diagnostic value of EBUS-TBNA for lung cancer reported a sensitivity, negative predictive value, and accuracy of 92%, 90%, and 95%, respectively.…”

“…By 2007, the American College of Chest Physicians and the US National Comprehensive Cancer Network jointly recommended EBUS‐TBNA as an important technique for preoperative evaluation 24,25 . Current indications for EBUS‐TBNA include diagnosis and staging of pulmonary malignancy, intrapulmonary and mediastinal masses, and unknown mediastinal and/or hilar lymphadenopathy 26 . Compared with minimally invasive surgical approaches, the advantages of an EBUS‐TBNA procedure comprise reduced trauma, blood loss, operation time, medical expenses, and real‐time elastography‐targeted biopsy for thoracic tumors 7,14,23 …”

The evolution of endobronchial ultrasound usage in modern era

“…Guidelines recommend EBUS as the primary approach for staging the mediastinum of lung cancer ( 3 , 4 ). Consistent with this, on a global scale, the primary applications of EBUS in general medical practice involve the identification of mediastinal and hilar lesions, as well as the staging of lymph nodes for lung cancer ( 5 ).…”

“…The need for sufficient tissue for accurate cancer diagnosis and molecular analysis has led the bronchoscopist to modify their usual approach to ensure sample adequacy. Consequently, there has been a noticeable increase in the development of novel EBUS applications extending beyond the traditional endobronchial approach ( 1 , 1 , 1 ). This review aims to highlight the diverse applications of convex probe EBUS beyond its conventional role in diagnosing and staging lung cancer.…”

“…Ultrasound elastography shows significant diagnostic efficacy in distinguishing between benign and malignant lesions such as the liver, kidney, pancreas, breast, thyroid, prostate, and lymph nodes. However, the ideal and established assessment approach for EBUS elastography remains uncertain, and there is a requirement for improvements in the performance of this technique as highlighted in much of the published research ( 5 , 27 , 28 ). In a metaanalysis including seventeen studies to investigate the impact of EBUS elastography for discrimination between benign and malignant hilar and mediastinal LNs., the authors showed the diagnostic performance of EBUS elastography for hilar and mediastinal lymph nodes is well-established, with a sensitivity of 0.90 (95% CI, 0.84-0.94) and a specificity of 0.78 (95% CI, 0.74-0.81) respectively ( 29 ).…”