Endobronchialer Ultraschall (EBUS) – Update 2017

Der endobronchiale Ultraschall (EBUS) hat im letzten Jahrzehnt die Lungenkrebsdiagnostik revolutioniert. Auch bei anderen Erkrankungen wie der Sarkoidose hat der Stellenwert dieses minimalinvasiven diagnostischen Verfahrens erheblich zugenommen und somit geholfen, unnötige diagnostische Operationen zu vermeiden. Dieser Übersichtsartikel stellt ein Update zum EBUS dar und erläutert die aktuellen und zukünftigen Entwicklungen dieses Verfahrens.

Abstract

Endobronchial Ultrasound (EBUS) with the two modalities curved and radial EBUS significantly improved the diagnostics in several pulmonary diseases. The examination and staging of mediastinal and hilar lymph nodes in patients with known or suspected lung malignancy as well as the evaluation of unknown pulmonary or mediastinal lesions can be achieved with minimal invasive means when using EBUS. More invasive surgical procedures for diagnostic purposes can be omitted. The diagnostic yield also increases when EBUS is applied in sarcoidosis or mediastinal lymph node tuberculosis but only to some extend in case of lymphoma. Samples obtained by EBUS-TBNA should be handled efficiently to allow molecular analysis in lung cancer. EBUS is a safe procedure, and complication rate is extremely low. Further advances of the EBUS technology focus on improving analysis of the information provided by the ultrasound image and a better tissue sampling by developing of new EBUS bronchoscopes and TBNA-needles.

Kernaussagen

• Eine exakte Kenntnis der mediastinalen Anatomie mit Identifikation aller Leitstrukturen im sonografischen Bild ist Voraussetzung für eine effiziente Durchführung der EBUS-TBNA.

• Die EBUS-TBNA kann als primäres Verfahren beim Lungenkarzinom zur Diagnosesicherung und zum Mediastinal-Staging eingesetzt werden.

• Die Komplikationsrate ist mit 0,05 % sehr gering. Dennoch müssen insbesondere Blutungen, Pneumothorax und Infektionen beachtet werden.

• Insbesondere im Stadium I ist die diagnostische Rate der EBUS-TBNA bei der Abklärung der Sarkoidose höher als bei einer konventionellen Bronchoskopie. Wahrscheinlich gilt dies auch für das Stadium II.

• In der Abklärung lymphoproliferativer Erkrankungen, insbesondere beim Hodgkin-Lymphom, ist die diagnostische Sicherheit schlechter als bei anderen Erkrankungen.

• Unklare histologische Ergebnisse bei suspekt vergrößerten Lymphknoten bedürfen zwingend der weiteren Abklärung, meist dann mittels Mediastinoskopie.

• Neu entwickelte EBUS-Nadeln wurden aus neuen Materialien produziert. Dies ermöglicht eine höhere Flexibilität, einen schärferen Schliff und einen größeren Innendurchmesser. Ob dies auch zu einer Verbesserung der Diagnostik führt, wird aktuell in Studien geklärt.

• Die radiäre Ultraschallsonde verbessert die Diagnostik peripherer Lungenherde.

Schlüsselwörter

EBUS - EUS - Bronchoskopie - Bronchialkarzinom - Sarkoidose

Keywords

EBUS - EUS - bronchoscopy - lung cancer - sarcoidosis

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