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Endobronchial Ultrasound (EBUS) Bronchoscopy Procedure
Dr. Xuanha “Mimi” White, a board-certified Internal Medicine, Pulmonary, Critical Care, and Sleep Medicine physician with Temecula Valley Hospital, discusses the Endobronchial Ultrasound (EBUS) Bronchoscopy Procedure.
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Learn more about Mimi White, MD
Mimi White, MD
Dr. Xuanha “Mimi” White is a board-certified Internal Medicine, Pulmonary, Critical Care, and Sleep Medicine physician. She is the medical director of Integra Sleep Diagnostic Center and President of Integra Health, PC.Learn more about Mimi White, MD
Transcription:
Melanie Cole, MS (Host): Welcome to TVH Healthchat with Temecula Valley Hospital. I'm Melanie Cole and today we’re discussing the endobronchial ultrasound bronchoscopy procedure, or EBUS, that’s available at Temecula Valley Hospital. Joining me is Dr. Mimi White. She’s board certified in internal medicine, pulmonary, critical care, and sleep medicine, and she’s a member of the medical staff at Temecula Valley Hospital. Dr. White, it’s a pleasure to have you join us today. Tell us about some of the latest pulmonary procedures. Tell us about endobronchial ultrasound. What is it and why is it used?
Mimi White, MD (Guest): I would like to discuss the EBUS procedure today. It is the endobronchial ultrasound bronchoscopy, one of the latest technology that was brought to Temecula within the last six months. The endobronchial ultrasound bronchoscopy is a minimally invasive but very highly effective procedure that we use to diagnose things like lung cancer, infections, and other diseases that causes enlarged lymph nodes in the chest. It is definitely a technology that improves our diagnosing of different type of pulmonary diseases. I think that will bring a lot of newer technology to the area that we are able to now offer as compared to before.
Host: Well thank you for that. So Dr. White, what's the role of EBUS in the staging of lung cancer? Since lungs are moving, how does that work when you're doing something like this?
Dr. White: Absolutely. So the sampling of a lymph node will give us a much better idea of different staging of lung cancer. So for example, lung cancer can present as a nodule inside the lung or a mass inside the lung with lymph nodes that are enlarged meaning that it has metastasized into the lymph nodes. If the lymph node that is biopsied is positive for the same type of cancer that is seen in the same nodule or mass that is inside the lung, that will increase the staging of the cancer. However if those lymph nodes are biopsied and they are negative, then of course it brings you to a much lower staging of lung cancer. Staging of lung cancer is very important to allow the oncologists, radiation oncology, to determine what are the best management for a patient’s cancer.
Host: Well then what's the difference between a traditional bronchoscopy and EBUS?
Dr. White: So a traditional bronchoscopy will not allow us to sample those lymph nodes. The EBUS allows us to use ultrasound technology to get to the lymph node. In fact, it is a real time diagnostic procedure where we are able to see the lymph nodes that we are sampling in real time with the needle going in and out of the lymph nodes so that we know that we are collecting samples from the collect lymph nodes, first of all, but also allowing us to have the capability of sampling those lymph nodes other than the regular bronchoscopy. The regular bronchoscopy will allow us to go and take samples from inside the lungs via the airway but not able to get to the lymph node itself.
Host: How cool is that technology? So what is it like for the patient, Dr. White? How long does the procedure take? Do they feel it? What's it like?
Dr. White: It is actually very simple for the patient. In fact it is no different than a regular bronchoscopy. The procedure itself can be anywhere between 30 minutes to an hour. Usually, right now, I am doing under general anesthesia. So the patient will be completely comfortable throughout the procedure as they already put to sleep by the anesthesiologist. Then, of course, during the duration of the procedure the anesthesiologist is managing their airway, their sedation. They are now, of course, under the care of two physicians in the bronchoscopy suite. So first of all very safe. Again, the procedure takes very minimal amount of time. Normally it takes me under an hour to complete the full procedure.
Host: Do they feel anything afterwards? Do they have a sore throat? Do they have any pain at all?
Dr. White: So a sore throat is always a small possibility because they are getting intubated for the general anesthesia. So they are getting what we call an endotracheal tube through the vocal cords into their trachea. So yes. They may have a little bit of a sore throat, hoarseness from the procedure. That usually goes away within 24 hours. There is no pain after the procedure at all even though we are sampling with the needle through the airway. Airway does not have a lot of pain receptors. So they are feeling pretty much back to normal after the procedure.
Host: That’s very encouraging for patients that need this test. So what about after? Can they eat soon? Are there limits such as hot liquids or alcohol? Anything along those lines?
Dr. White: Sure. After the procedure depending on how they respond to the anesthesia and the sedation, we recommend not eating until they are fully awake after the anesthesia wears off. That’s just to prevent the sedation causing them to choke on their food, aspirating into the lungs. Outside of that, they can usually go back to complete normal eating and normal food.
Host: What about the results? You mentioned that this was in real time. So if you're sampling them, you obviously can't get the biopsy results right then. Who interprets the results, and how soon does the patient get them after this type of procedure?
Dr. White: Yeah. That’s a great question because Temecula Valley Hospital is actually allowing us to have a pathologist in the room with us while we are doing the procedure. Mostly for actually checking the accuracy of sampling. So the pathologists, there's a couple that I've worked with in the hospital. So every time that I am doing an EBUS procedure I will ask them to be a part of the procedure. They are in the room preparing the slides as I am getting the samples. So first of all they’ll let me know if I am in the lymph node meaning that they will be checking to see if there are lymph tissues inside the sample that I am getting. Then they will let me know if the sample looks to be adequate so that they can run multiple different tests on there. If a sample that I'm getting is too small then they will let me know and I can go ahead and get more samples. That improves the yield of the procedure. So that’s the first thing.
Then secondly if there are any cancer cells that they can see immediately then they will let me know that they think that there is some atypical cells. Normally I would not be sharing that information with a patient right away until there are more confirmatory testing that can be done, usually something called flow cytometry to look for specific types of cancer. Usually that will take anywhere from three to five working days. I have had very, very quick results from the pathology department in Temecula Valley. So usually I'm bringing my patient back to follow up in a week or a week and a half to discuss results with them. I've always had the results in a timely manner. So I would say probably within a week to two weeks you would get an answer.
Host: Then what’s the next step for patients? If they do get bad news then who do they see right after that?
Dr. White: So it would be an oncologist. So a physician who is a specialist in treating cancer. I would normally start with that, but hey can also possibly see a radiation oncologist meaning a cancer doctor who specializes in radiation treatment. Then if they are a candidate may also see a cardio thoracic surgeon who will offer surgical options for treatment such as removal of the nodule, mass, or even lymph nodes. In fact, that is why it is so important for our patient to get the correct staging of the cancer because it depends on the staging what type of therapy there will be available for them.
Host: As we’re wrapping up Dr. White, and this is really such an interesting procedure, what would you like patients to know if they're considering EBUS if it’s something that’s been recommended? One thing we didn’t cover is who do you recommend it for? When would this be considered? Just kind of summarize everything for us.
Dr. White: Absolutely. So first of all, one of the take home message I would like to share with a patient is that lung cancer no longer has to be a death sentence. In fact, if you find a nodule that could potentially be lung cancer and you diagnose it early, there are so many different treatment modalities that are available now for the patient. Patients can live full lives. I have had actually a handful of patients who have been cured from their lung cancer depending on the timing of diagnosis. So that’s why it’s so important to be able to figure these lung cancers out early, get as early staging as you can. Of course when you are in earlier stages, you chance of survival just as that much better. So getting early diagnosis is the key.
That brings me to what type of patients should be getting a treatment or should be getting at least looked at. Usually by the ATS guidelines and the American Lung Cancer Society guidelines, patients who have had a significant smoking history of 30 pack a year or more definitely should have a lung cancer screening. In fact, they recommend anywhere from 55 to 75 as the age group with a significant smoking history to get yearly low dose CAT scan to look for lung nodules that may pop up. Then, of course, lung nodules that are popping up should be evaluated by a pulmonologist who can then guide the patient into the next step of getting that looked at.
Host: Well thank you for coming on Dr. White. It’s really fascinating procedure that you're performing there at Temecula Valley Hospital. Thank you for coming on and sharing your expertise with us today. That concludes this episode of TVH Healthchat with Temecula Valley Hospital. Please visit our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Temecula Valley Hospital podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.
Melanie Cole, MS (Host): Welcome to TVH Healthchat with Temecula Valley Hospital. I'm Melanie Cole and today we’re discussing the endobronchial ultrasound bronchoscopy procedure, or EBUS, that’s available at Temecula Valley Hospital. Joining me is Dr. Mimi White. She’s board certified in internal medicine, pulmonary, critical care, and sleep medicine, and she’s a member of the medical staff at Temecula Valley Hospital. Dr. White, it’s a pleasure to have you join us today. Tell us about some of the latest pulmonary procedures. Tell us about endobronchial ultrasound. What is it and why is it used?
Mimi White, MD (Guest): I would like to discuss the EBUS procedure today. It is the endobronchial ultrasound bronchoscopy, one of the latest technology that was brought to Temecula within the last six months. The endobronchial ultrasound bronchoscopy is a minimally invasive but very highly effective procedure that we use to diagnose things like lung cancer, infections, and other diseases that causes enlarged lymph nodes in the chest. It is definitely a technology that improves our diagnosing of different type of pulmonary diseases. I think that will bring a lot of newer technology to the area that we are able to now offer as compared to before.
Host: Well thank you for that. So Dr. White, what's the role of EBUS in the staging of lung cancer? Since lungs are moving, how does that work when you're doing something like this?
Dr. White: Absolutely. So the sampling of a lymph node will give us a much better idea of different staging of lung cancer. So for example, lung cancer can present as a nodule inside the lung or a mass inside the lung with lymph nodes that are enlarged meaning that it has metastasized into the lymph nodes. If the lymph node that is biopsied is positive for the same type of cancer that is seen in the same nodule or mass that is inside the lung, that will increase the staging of the cancer. However if those lymph nodes are biopsied and they are negative, then of course it brings you to a much lower staging of lung cancer. Staging of lung cancer is very important to allow the oncologists, radiation oncology, to determine what are the best management for a patient’s cancer.
Host: Well then what's the difference between a traditional bronchoscopy and EBUS?
Dr. White: So a traditional bronchoscopy will not allow us to sample those lymph nodes. The EBUS allows us to use ultrasound technology to get to the lymph node. In fact, it is a real time diagnostic procedure where we are able to see the lymph nodes that we are sampling in real time with the needle going in and out of the lymph nodes so that we know that we are collecting samples from the collect lymph nodes, first of all, but also allowing us to have the capability of sampling those lymph nodes other than the regular bronchoscopy. The regular bronchoscopy will allow us to go and take samples from inside the lungs via the airway but not able to get to the lymph node itself.
Host: How cool is that technology? So what is it like for the patient, Dr. White? How long does the procedure take? Do they feel it? What's it like?
Dr. White: It is actually very simple for the patient. In fact it is no different than a regular bronchoscopy. The procedure itself can be anywhere between 30 minutes to an hour. Usually, right now, I am doing under general anesthesia. So the patient will be completely comfortable throughout the procedure as they already put to sleep by the anesthesiologist. Then, of course, during the duration of the procedure the anesthesiologist is managing their airway, their sedation. They are now, of course, under the care of two physicians in the bronchoscopy suite. So first of all very safe. Again, the procedure takes very minimal amount of time. Normally it takes me under an hour to complete the full procedure.
Host: Do they feel anything afterwards? Do they have a sore throat? Do they have any pain at all?
Dr. White: So a sore throat is always a small possibility because they are getting intubated for the general anesthesia. So they are getting what we call an endotracheal tube through the vocal cords into their trachea. So yes. They may have a little bit of a sore throat, hoarseness from the procedure. That usually goes away within 24 hours. There is no pain after the procedure at all even though we are sampling with the needle through the airway. Airway does not have a lot of pain receptors. So they are feeling pretty much back to normal after the procedure.
Host: That’s very encouraging for patients that need this test. So what about after? Can they eat soon? Are there limits such as hot liquids or alcohol? Anything along those lines?
Dr. White: Sure. After the procedure depending on how they respond to the anesthesia and the sedation, we recommend not eating until they are fully awake after the anesthesia wears off. That’s just to prevent the sedation causing them to choke on their food, aspirating into the lungs. Outside of that, they can usually go back to complete normal eating and normal food.
Host: What about the results? You mentioned that this was in real time. So if you're sampling them, you obviously can't get the biopsy results right then. Who interprets the results, and how soon does the patient get them after this type of procedure?
Dr. White: Yeah. That’s a great question because Temecula Valley Hospital is actually allowing us to have a pathologist in the room with us while we are doing the procedure. Mostly for actually checking the accuracy of sampling. So the pathologists, there's a couple that I've worked with in the hospital. So every time that I am doing an EBUS procedure I will ask them to be a part of the procedure. They are in the room preparing the slides as I am getting the samples. So first of all they’ll let me know if I am in the lymph node meaning that they will be checking to see if there are lymph tissues inside the sample that I am getting. Then they will let me know if the sample looks to be adequate so that they can run multiple different tests on there. If a sample that I'm getting is too small then they will let me know and I can go ahead and get more samples. That improves the yield of the procedure. So that’s the first thing.
Then secondly if there are any cancer cells that they can see immediately then they will let me know that they think that there is some atypical cells. Normally I would not be sharing that information with a patient right away until there are more confirmatory testing that can be done, usually something called flow cytometry to look for specific types of cancer. Usually that will take anywhere from three to five working days. I have had very, very quick results from the pathology department in Temecula Valley. So usually I'm bringing my patient back to follow up in a week or a week and a half to discuss results with them. I've always had the results in a timely manner. So I would say probably within a week to two weeks you would get an answer.
Host: Then what’s the next step for patients? If they do get bad news then who do they see right after that?
Dr. White: So it would be an oncologist. So a physician who is a specialist in treating cancer. I would normally start with that, but hey can also possibly see a radiation oncologist meaning a cancer doctor who specializes in radiation treatment. Then if they are a candidate may also see a cardio thoracic surgeon who will offer surgical options for treatment such as removal of the nodule, mass, or even lymph nodes. In fact, that is why it is so important for our patient to get the correct staging of the cancer because it depends on the staging what type of therapy there will be available for them.
Host: As we’re wrapping up Dr. White, and this is really such an interesting procedure, what would you like patients to know if they're considering EBUS if it’s something that’s been recommended? One thing we didn’t cover is who do you recommend it for? When would this be considered? Just kind of summarize everything for us.
Dr. White: Absolutely. So first of all, one of the take home message I would like to share with a patient is that lung cancer no longer has to be a death sentence. In fact, if you find a nodule that could potentially be lung cancer and you diagnose it early, there are so many different treatment modalities that are available now for the patient. Patients can live full lives. I have had actually a handful of patients who have been cured from their lung cancer depending on the timing of diagnosis. So that’s why it’s so important to be able to figure these lung cancers out early, get as early staging as you can. Of course when you are in earlier stages, you chance of survival just as that much better. So getting early diagnosis is the key.
That brings me to what type of patients should be getting a treatment or should be getting at least looked at. Usually by the ATS guidelines and the American Lung Cancer Society guidelines, patients who have had a significant smoking history of 30 pack a year or more definitely should have a lung cancer screening. In fact, they recommend anywhere from 55 to 75 as the age group with a significant smoking history to get yearly low dose CAT scan to look for lung nodules that may pop up. Then, of course, lung nodules that are popping up should be evaluated by a pulmonologist who can then guide the patient into the next step of getting that looked at.
Host: Well thank you for coming on Dr. White. It’s really fascinating procedure that you're performing there at Temecula Valley Hospital. Thank you for coming on and sharing your expertise with us today. That concludes this episode of TVH Healthchat with Temecula Valley Hospital. Please visit our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Temecula Valley Hospital podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.