Expired CME Article

Endobronchial Ultrasound in the Evaluation of Lung Cancer: A Practical Review and Cost Analysis for the Practicing Pulmonologist

Authors: Mark R. Bowling, MD, C David Perry, MD, Robert Chin, Jr., MD, Norman Adair, MD, Arjun Chatterjee, MD, MS, John Conforti, DO

Abstract

Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new technology utilized with bronchoscopy that has been shown to identify bronchial wall invasion by malignant tumors, aid in the fine needle aspiration of peripheral lung lesions and mediastinal/hilar lymph nodes, and determine the course of treatment in patients with pulmonary carcinoma in situ. The decision to invest both time and money in this technology is determined by several factors such as the cost of the equipment, reimbursement for the procedure, availability of training, the number of bronchoscopies one performs in a year, and access to endoscopic ultrasound and mediastinoscopy. This article reviews the literature to determine the utility of endobronchial ultrasound in the management of patients with lung cancer and to provide information to practicing pulmonologists that may aid in determining whether and where this technology fits into their clinical armamentarium.


Key Points


* Endobronchial ultrasound is a useful tool in the evaluation of patients with lung cancer.


* The convex probe endobronchial video bronchoscope is the most practical device to aid in the sampling of the mediastinal and hilar lymph nodes for transbronchial needle aspiration.


* The cost effectiveness of endobronchial ultrasound may be determined by several factors such as: the number of transbronchial needle aspirations one performs per year, the number of patients evaluated per year with lymph nodes less than 1 cm, and the number of patients evaluated per year with lymph node locations besides American Thoracic Society 4R and 7.

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