Complex technical problems interfered with the application of thoracic ultrasound (US) for studies and clinical research. Moreover, in contrast to radiologists, cardiologists, gastroenterologists, internists, obstetricians, gynecologists and others, pulmonologists were not trained in the basics of US images. However, endoscopic US methods were developed in the last 20 years and these methods also provided important results for pulmonologists. As soon as the technical problems interfering with US application in air-containing spaces were solved, endobronchial US (EBUS) became a valuable technique as well. With EBUS, the delicate multilayer structure of the tracheobronchial wall can be analyzed. This knowledge became decisive for the management of early cancer in the central airways. These lesions can undergo local treatment instead of surgical intervention if the bronchial cartilage is intact and if the adjacent lymph nodes are not involved. EBUS proved valuable as well for the staging of more advanced lung cancer, especially with regard to endoluminal, intramural and extraluminal tumor spread. Endobronchial endosonographers are able to diagnose mediastinal lymph nodes similar to the experience of gastrointestinal endosonographers. EBUS-guided transbronchial needle aspiration (TBNA) improved the results of N-staging of lung cancer, especially in difficult lymph node levels without any clear endoscopic landmarks. The possibility of identifying N2 and N3 stages by means of a nonsurgical procedure can modify the management of lung cancer and decrease the number of unnecessary surgical interventions. EBUS can reduce the need for more invasive procedures such as thoracoscopy or mediastinoscopy. It is also useful for biopsying peripheral lesions or solitary pulmonary nodules instead of fluoroscopic guidance and also plays an important role in the strategy of interventional endoscopy.

Keywords:
Endobronchial ultrasound, Ultrasound, Endoscopic ultrasound, Lung cancer diagnosis, Lung cancer staging, Bronchoscopy, Transbronchial needle aspiration
1.
Beckh S, Bölcskei PL, Lessnau KD: Real-time chest ultrasonography: A comprehensive rewiew for the pulmonologist. Chest 2002;122:1759–1773.
2.
Goldberg BB: Suprasternal sonography. JAMA 1971;15:245–250.
3.
Wernecke K, Peters PE, Galanski M: Mediastinal tumours: Evaluation with suprasternal sonography. Radiology 1986;159:405–409.
4.
Wernecke K, Vassallo P, Pötter R, Luckener HG, Peters PE: Mediastinal tumours: Sensitivity and detection with sonography compared with CT and radiography. Radiology 1990;175:137–143.
5.
American Society for Gastrointestinal Endoscopy: Role of endoscopic ultrasonography. Gastrointest Endosc 2000;52:852–859.
6.
Mountain CF, Dresler CM: Regional lymph node classification for lung cancer staging. Chest 1997;111:1718–1723.
7.
Mountain CF: Revision in the international system for staging lung cancer. Chest 1997;111:1710–1717.
8.
Fickling W, Fallace M: EUS in lung cancer. Gastrointest Endosc 2002;56:S18–S21.
9.
Becker HD, Lam S: Future diagnostic procedures. Chest Surg Clin N Am 1996;6:363–380.
10.
Kumegawa H: Study of the endoscopic ultrasonography for esophageal carcinoma. Jpn J Gastroenterol Surg 1985;18:1774–1783.
11.
Murata Y, Muroi M, Yoshida M, Okushima N, Sugiyama A, Ide H: Endoscopic ultrasonography in the diagnosis of esophageal carcinoma. J Jpn Bronchoesophagol Soc 1986;37:378–385.
12.
Naruke T, Suemasu K, Ishikawa S: Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832–839.
13.
Kondo D, Imaizumi M, Abe T, Naruke T, Suemasu K: Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer. Chest 1990;98:586–593.
14.
Catalano MF, Sivak MV Jr, Rice T, Gragg LA, Van Dam J: Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc 1994;40:442–446.
15.
Bhutani MS, Haves RH, Hoffman BJ: A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc 1997;45:474–479.
16.
Loren DE, Seghal CM, Ginsberg GG, Kochman ML: Computer-assisted analysis of lymph nodes detected by EUS in patients with esophageal carcinoma. Gastrointest Endosc 2002;56:742–746.
17.
Wiersema MJ, Kochman ML, Cramer HM, Wiersema LM: Preoperative staging of non-small cell lung cancer: Transesophageal US-guided fine-needle aspiration biopsy of mediastinal lymph nodes. Radiology 1994;190:239–242.
18.
Wang KP, Terry B: Transbronchial needle aspiration in the diagnosis and staging of bronchogenic carcinoma. Am Rev Respir Dis 1983;127:344–347.
19.
Pedersen BH, Vilmann P, Folke K, Jacobsen GK, Krasnik M, Milmann N, Hancke S: Endoscopic ultrasonography and real-time guided fine-needle aspiration biopsy of solid lesions of the mediastinum suspected of malignancy. Chest 1996;110:539–544.
20.
Silvestri GA, Hoffman BJ, Bhutani MS, Hawes RH, Coppage L, Sanders-Cliette A, Reed CE: Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann Thorac Surg 1996;61:1441–1445.
21.
Gress FG, Savides TJ, Sandler A, Kesler K, Conces D, Cummings O, Mathur P, Ikenberry S, Bilderback S, Hawes R: Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small cell lung cancer: A comparison study. Ann Intern Med 1997;127:604–612.
22.
Fritscher-Ravens A, Sohendra N, Shirrow L, Sriram PVJ, Meyer A, Hauber HP, Pforte A: Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer. Chest 2000;117:339–345.
23.
Catalano MF, Nayar R, Gress F, Scheiman J, Wassef W, Rosenblatt ML, Kochman M: EUS-guided fine needle aspiration in mediastinal lymphadenopathy of unknown etiology. Gastrointest Endosc 2002;55:863–869.
24.
Devereux BM, LeBlanc JK, Yousif E, Kesler K, Brooks JA, Mathur P, Sandler A, Chappo J, Lehman GA, Sherman S, Gress F, Ciaccia D: Clinical utility of EUS-guided fine-needle aspiration of mediastinal masses in the absence of known pulmonary malignancy. Gastrointest Endosc 2002:56:397–401.
25.
Ikenberry S, Gress F, Savides T, Hawes R: Fine-needle aspiration of posterior mediastinal lesions guided by radial scanning endosonography. Gastrointest Endosc 1996;43:605–609.
26.
Gress F, Hawes R, Savides T, Ikenberry S, Lehman GA: Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography. Gastrointest Endosc 1997;45:243–250.
27.
Brand B, Ponnudurai R, Ryozawa S, Mendes KL, Yang AM, Bohnacker S, Seitz U, Soehendra N: A new radial mechanical puncture echoendoscope: Prospective comparison with standard linear and radial echoendoscopes in assessment of focal pancreatic lesions. Gastrointest Endosc 2002;55:249–254.
28.
Chak A: Endoscopic ultrasound-guided fine-needle aspiration: Time to temper enthusiasm with caution. Gastrointest Endosc 1997;46:286–287.
29.
Hurther T, Hanrath P: Endobronchial sonography: Feasibility and preliminary results. Thorax 1992;47:565–567.
30.
Becker HD: Endobronchial ultrasound – Expensive toy or useful tool? Proceedings of the 8th World Congress for Bronchology and the 8th World Congress for Bronchooesophagology, Munich, 1994 (abstract No 237).
31.
Goldberg BB, Steiner RM, Liu JB, Merton DA, Articolo G, Cohn JR, Gottlieb J, McComb BL, Spirn PW: US-assisted bronchoscopy with use of miniature transducer-containing catheters. Radiology 1994;190:233–237.
32.
Shannon JJ, Bude RO, Orens JB, Becker FS, Whyte RI, Rubin JM, Quint LE, Martinez FJ: Endobronchial ultrasound-guided needle aspiration of mediastinal adenopathy. Am J Respir Crit Care Med 1996;153:1424–1430.
33.
Herth F, Becker HD: Endobronchial ultrasound of the airways and the mediastinum. Monaldi Arch Chest Dis 2000;551:36–44.
34.
Falcone F, Fois F, Patelli M, Grosso D, Poletti V, Tosto L, Lazzari L: Feasibility of endobronchial sonography (EBUS): Preliminary results in Italian experience; in Yoshimura H (ed): Bronchology and Bronchoesophagology: State of the art. Oxford, Elsevier Science, 2001, pp 905–908.
35.
Steiner RM, Liu JB, Goldberg BB, Cohn JR: The value of ultrasound-guided fiberoptic bronchoscopy. Clin Chest Med 1995;16:519–534.
36.
Tanaka F, Muro K, Yamasaki S, Watanabe G, Shimada Y, Imamura M, Hitomi S, Wada H: Evaluation of tracheo-bronchial wall invasion using transbronchial ultrasonography (TBUS). Eur J Cardiothorac Surg 2000;17:570–574.
37.
Okamoto H, Watanabe K, Nagatomo A, Kunikane H, Aono H, Yamagata T, Kase M: Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer. Chest 2002;121:1498–1506.
38.
Herth F, Becker HD, LoCicero Jr. J, Ernst A: Endobronchial ultrasound in therapeutic bronchoscopy. Eur Respir J 2002;20:118–121.
39.
Herth F, Becker HD, Manegold C, Drings P: Endobronchial ultrasound (EBUS): assessment of a new diagnostic tool in bronchoscopy for staging of lung cancer. Onkologie 2001;24:151–154.
40.
Becker HD, Herth F: Why endobronchial ultrasound (EBUS) will be an indispensable tool for bronchoscopy. J Bronchol 2001;9:146–151.
41.
Becker HD: Endobronchialer Ultraschall. Eine neue Perspektive in der Bronchologie. Ultraschall Med 1996;17:106–112.
42.
Kurimoto N, Murayama M, Kohama Y, Enomoto M, Nishisaka T, Inai K: Clinical application of endobronchial ultrasound in the diagnosis of bronchial and peri-bronchial diseases. Jpn J Clin Radiol 1997;42:143–150.
43.
Kurimoto N, Murayama M, Morita K, Kobayashi A, Uomoto M: Clinical applications of endobronchial ultrasonography in lung diseases. Endoscopy 1998;suppl 30:A8–A12.
44.
Kurimoto N, Murayama M, Yoshioka S, Nishisaka T, Inai K, Dohi K: Assessment of usefulness of endobronchial ultrasonography in determination of depth of tracheobronchial tumour invasion. Chest 1999;115:1500–1506.
45.
Baba M, Sekine Y, Suzuki M, Yoshida S, Shibuya K, Iisaza T, Saitoh Y, Onuma EK, Ohwada H, Fujisawa T: Correlation between endobronchial ultrasonography (EBUS) images and histologic findings in normal and tumour-invaded bronchial wall. Lung Cancer 2002;35:65–71.
46.
Miyazu Y, Miyazawa T, Iwamoto Y, Kano K, Kurimoto N: The role of endoscopic techniques, laser-induced fluorescence endoscopy, and endobronchial ultrasonography in choice of appropriate therapy for bronchial cancer. J Bronchol 2000;8:10–16.
47.
Burgers JA, Herth F, Becker HD: Endobronchial ultrasound. Lung Cancer 2001;24:S109–S113.
48.
Herth F, Becker HD: New staging procedures in lung cancer: Endobronchial ultrasound. Lung Cancer 2001;32(suppl 1):S9–S11.
49.
Miyazu Y, Miyazawa T, Kurimoto N, Iwamoto Y, Kanoh K, Kohno N: Endobronchial ultrasonography in the assessment of centrally located early-stage lung cancer before photodynamic therapy. Am J Respir Crit Care Med 2002;165:832–837.
50.
Herth F, Becker HD, LoCicero J, Ernst A: Endobronchial ultrasound improves classification of suspicious lesions detected by autofluorescence-bronchoscopy, in press.
51.
Harrow EM, Abi-Saleh W, Blum J, Harkin T, Gasparini S, Addrizzo-Harris, Arroliga AC, Wight G, Mehta AC: The utility of transbronchial needle aspiration in the staging of bronchogenic carcinoma. Am J Respir Crit Care Med 2000;161:601–607.
52.
Herth F, Hecker E, Hoffmann H, Becker HD: Endobronchial ultrasound for local tumour and lymph node staging in patients with centrally growing lung cancer. Endobronchialer Ultraschall 2002;23:251–255.
53.
Herth F, Becker HD, Ernst A: Conventional vs Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). A randomized trial, in press.
54.
Reichenberger F, Weber J, Tamm M, Bolliger CT, Dalquen P, Perruchoud AP, Soler M: The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. Chest 1999;116:704–708.
55.
White CS, Weiner EA, Patel P, Britt EJ: Transbronchial needle aspiration: Guidance with CT fluoroscopy. Chest 2000;118:1630–1638.
56.
Falcone F, Fois F, Grosso D, Patelli M, Lazzari Agli L, Trisolini R: Is endobronchial ultrasound (EBUS) indispensable in clinical practice. Con: EBUS is not indispensable in clinical practice. J Bronchol 2001;9:152–157.
57.
Herth F, Ernst A, Becker HD: Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions. Eur Respir J 2002;20:972–974.
58.
Omori S, Takiguchi Y, Hiroshima K, Tanabe N, Tatsumi K, Rimura H, Nagao K, Kuriyama T: Peripheral pulmonary diseases: Evaluation with endobronchial US. Initial experience. Radiology 2002;224:603–608.
59.
Nakamura H, Kawasaki N, Hagiwara M, Ogata A, Kato H: Endoscopic evaluation of centrally located early squamous cell carcinoma of the lung. Cancer 2001;91:1142–1147.
60.
Van Klaveren RJ, Habbema JDF, Pedersen JH, de Koning HJ, Oudkerk M, Hoogsteden HC: Lung cancer screening by low-dose spiral computed tomography. Eur Respir J 2001;18:857–866.
61.
Bolliger CT, Heussinger K: Early detection of lung cancer. Eur Respir Monogr 1998;3:22–35.
62.
Tissue is the issue: Is endoscopic ultrasonography with or without fine-needle aspiration biopsy in the staging on non small cell lung cancer an advance (editorial). Ann Intern Med 1997;127:643–645.
63.
Bolliger CT, Mathur PN, Beamis JF, Becker HD, Cavaliere S, Colt H, Diaz-Jimenez JP, Dumon JF, Edell E, Kovitz KL, Macha HN, Mehta AC, Marel M, Noppen M, Strausz J, Sutedja TG: ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002;19:356–373.
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