The rise of Endobronchial Ultrasound (EBUS) and fall of Mediastinoscopy

ABSTRACT

Introduction: For over 50 years mediastinoscopy was considered the gold-standard to sample the mediastinum. The introduction of EBUS-TBNA (endobronchial ultrasound - transbronchial needle aspiration) revolutionised the diagnosis and staging of lung cancer and the diagnosis of metastases and investigation of isolated mediastinal and hilar lymphadenopathy. Objective(s) We aim to examine the relation between the number of EBUS and mediastinoscopy procedures performed in a large regional Cancer Alliance. Methodology A retrospective observational study of the number of EBUS and Mediastinoscopy procedures performed in the Greater Manchester Cancer Alliance between 2011-2020. Result(s) The number of EBUS procedures performed increased annually, from 362 in 2013 to a peak of 1,660 in 2019. There was a decline in in 2020 owing to the COVID-19 pandemic but this has recovered again in 2021 (n=1565). The number of mediastinoscopies was inversely proportional and declined on an annual basis with 179 performed in 2011, reducing to 21 in 2020 Conclusion(s) EBUS is now a widely available and highly adopted procedure for sampling the mediastinum. The number of procedures performed has increased on an annual basis and led to a reduction in the need for undertaking mediastinoscopies. The less invasive nature of EBUS has likely lowered the threshold for sampling the mediastinum to investigate benign conditions such as tuberculosis and sarcoidosis.