What Is EBUS? How Is It Performed? What Are Its Risks?

Today, in the diagnosis of lung diseases, not only imaging methods but also pathological examinations carried out by taking samples from diseased tissue are of great importance. Particularly in lung cancer, evaluation of the tumor tissue and lymph nodes is necessary in order to reach an accurate diagnosis, determine the stage of the disease and plan the most appropriate treatment for the patient. At this point, EBUS stands out as an important diagnostic method in pulmonology practice. Pulmonology Specialist Asst. Prof. Seha Akduman explained what people want to know about the EBUS procedure.

What Does EBUS Stand For?

EBUS, a modern, minimally invasive method with high diagnostic value that today holds an important place in the diagnosis and staging of lung diseases, and lung cancer in particular, stands for Endobronchial Ultrasound.

What Is EBUS?

EBUS is an advanced bronchoscopic method that combines bronchoscopy with ultrasound technology and allows the lymph nodes around the airways and certain lung lesions to be evaluated under real-time ultrasound imaging. During the procedure, a special bronchoscope with an ultrasound probe at its tip is advanced into the airways through the mouth. Thanks to ultrasound, the lymph nodes around the lungs and inside the chest cavity, which cannot be seen directly with standard bronchoscopy, can be visualized. Samples are taken from the areas deemed necessary with a special needle under ultrasound guidance (EBUS-TBNA). One of the most important features of this method is that the needle is guided to the targeted lymph node or lesion under real-time imaging. This makes it possible to take the sample from the right area.

What Is EBUS Performed For?

One of the most important uses of EBUS is the diagnosis and staging of lung cancer. However, its use is not limited to this. EBUS can be used in the following situations:

• Diagnosis when lung cancer is suspected
• Evaluation and staging of the lymph nodes inside the chest in lung cancer
• Re-evaluation of the disease after treatment
• Diseases such as sarcoidosis
• Diagnosis of tuberculosis and other infectious diseases
• Evaluation of certain lymph node diseases, primarily lymphomaEnlarged lymph nodes of unknown cause inside the chest cavity

EBUS has become an important diagnostic option, particularly in the evaluation of mediastinal or hilar lymph nodes that appear enlarged or metabolically active on computed tomography or PET/CT.

How Is EBUS Performed?

The following steps are carried out in order for the EBUS procedure:

• Before the procedure, the patient's general health, the medications they use, blood-thinning treatments and the necessary laboratory results are evaluated. 
• The patient is prepared appropriately and sedation/anesthesia is administered. 
• The bronchoscope is advanced into the airways through the mouth. 
• Ultrasound-probe imaging is used to visualize the lymph nodes inside the chest and the targeted structures.
• Samples are taken from the lymph nodes or lesions deemed appropriate with a special needle under ultrasound guidance.
• The samples taken are sent to the pathology laboratory and, when deemed necessary, advanced pathological and molecular examinations are carried out.

Carrying out the EBUS procedure in coordination with the pathology team can make it possible to assess whether the sample taken is diagnostically adequate and, if necessary, to adjust the sampling strategy during the procedure.

Why Is the EBUS Procedure Important in Lung Cancer?

In lung cancer, knowing the answer to the question "Is There Cancer?" is not enough. The type of cancer, the characteristics of the tumor and the stage of the disease are of critical importance in determining treatment. For example, determining whether tumor cells are present in the lymph nodes inside the chest can change whether the patient is suitable for surgical treatment or whether non-surgical treatments are needed. For this reason, accurate staging in lung cancer is one of the most important steps of the treatment plan.
Current international guidelines recommend EBUS and other endosonographic methods as a less invasive option than surgical mediastinoscopy for the tissue evaluation of mediastinal lymph nodes in suitable patients. EBUS does not only establish a diagnosis; it also contributes to treatment planning. Samples obtained with EBUS are not used only to show the presence of cancer cells. They can also be used to determine the histological type of the tumor, for immunohistochemical examinations, to evaluate markers important in the choice of treatment such as PD-L1, and to perform molecular/genetic analyses in suitable patients. For this reason, EBUS today is not just a "biopsy method" but an important part of the diagnostic process of personalized lung cancer treatment.

Is the EBUS Procedure Painful?

EBUS is usually performed under sedation or appropriate anesthesia. For this reason, most patients do not feel pain during the procedure or experience very little discomfort. After the procedure, there may be short-term throat irritation, coughing or mild chest discomfort. These are mostly temporary. Evaluating the patient before the procedure, choosing the appropriate anesthesia/sedation method and close monitoring during the procedure are important for patient comfort.

What Are the Risks of the EBUS Procedure?

One of the questions patients most often ask before EBUS is "Is the EBUS Procedure Dangerous?". When performed by experienced teams under appropriate conditions, EBUS is generally a safe and minimally invasive procedure. As with any medical procedure, EBUS also has certain risks. The following are among the risks of the EBUS procedure:

• Coughing
• Temporary discomfort in the throat or minor bleeding

More serious complications are quite rare. In a large series published in 2026 that evaluated 3,454 EBUS procedures, the vast majority of complications were mild, and the rate of serious complications was found to be quite low. The safety of the procedure is closely related to the patient's general health, the anesthesia method used, the location and number of samples to be taken and, most importantly, the experience of the team performing the procedure. 

What Are the Advantages of the EBUS Procedure?

The most important advantage of EBUS is that samples can be taken from the lymph nodes inside the chest and from suitable lesions without the need to surgically open the chest cavity or perform more invasive surgical procedures. The main advantages of the EBUS procedure are as follows:

• It is minimally invasive. It is less invasive than surgical methods and does not require a surgical incision.
• It provides real-time imaging. The targeted lymph node or lesion is sampled while being viewed under ultrasound.
• It can provide diagnosis and staging in the same procedure. Particularly in lung cancer, it helps evaluate the spread of the disease inside the chest.
• It can provide material for pathological and molecular examinations. This is especially valuable for personalized cancer treatments, which are becoming increasingly important today.

Selecting the right lymph node, correctly interpreting the ultrasound image, using the appropriate sampling technique and assessing the adequacy of the material obtained for pathology play an important role in the success of the procedure. For this reason, performing EBUS in collaboration between an experienced pulmonologist and an experienced pathology team is an important part of the diagnostic process.
The pathological evaluation of the samples obtained during EBUS is of great importance not only for reaching a diagnosis but also for determining the subtype of lung cancer, staging the disease and, in suitable patients, carrying out additional examinations that will guide treatment. In patients with suspected lung cancer, rather than relying only on imaging results, obtaining a tissue diagnosis when necessary and accurately determining the spread of the disease are of critical importance for choosing the right treatment for the patient. You too can benefit from experienced specialist support by making an appointment at Yeditepe University Hospitals.