An EBUS test, or endobronchial ultrasound, is a minimally invasive bronchoscopic procedure used to examine and sample lymph nodes or masses next to the major airways. An ultrasound probe on the bronchoscope allows the doctor to see structures beyond the airway wall and guide a needle into them in real time. EBUS-TBNA is commonly used to investigate enlarged chest lymph nodes, diagnose conditions such as tuberculosis and sarcoidosis, and diagnose or stage lung cancer. It is usually performed with sedation and many patients can go home the same day.

Most people first hear the term EBUS after a CT or PET-CT report mentions enlarged mediastinal or hilar lymph nodes.

The mediastinum is the central part of the chest between the lungs. It contains the windpipe, major bronchi, lymph nodes, major blood vessels, nerves, oesophagus and heart.

A CT scan can show that a lymph node is enlarged, but imaging alone cannot always tell why it is enlarged.

That is where EBUS can help.

With EBUS, a pulmonologist can view lymph nodes through the airway wall using ultrasound and obtain tissue with a fine needle without making an incision in the chest.

For information about the procedure available locally, see our EBUS test in Chandigarh page.

What exactly is an EBUS test?

EBUS stands for endobronchial ultrasound.

It combines two technologies:

• Bronchoscopy, which allows the doctor to enter and examine the airways

• Ultrasound, which allows the doctor to see structures lying outside the airway wall

A specialised bronchoscope has an ultrasound transducer at its tip.

Once a lymph node or mass is identified, a needle can be passed through the airway wall into the target while the doctor watches its position using ultrasound.

This sampling technique is called EBUS-guided transbronchial needle aspiration, or EBUS-TBNA.

The collected cells and tissue can then be examined for cancer, granulomatous disease and infection, and sent for microbiological or molecular tests when appropriate.

Why is an EBUS test done?

EBUS is mainly used when doctors need a tissue sample from lymph nodes or masses close to the trachea and major bronchi.

Common reasons include:

1. Staging or diagnosing lung cancer

2. Investigating tuberculosis involving chest lymph nodes

3. Investigating suspected sarcoidosis

4. Evaluating unexplained mediastinal or hilar lymph-node enlargement

5. Sampling selected central lung or mediastinal masses

6. Investigating suspected lymphoma or metastatic cancer in selected cases

The 2023 Joint Indian Chest Society and Indian Association for Bronchology guideline recommends EBUS-TBNA as the preferred initial approach for sampling accessible mediastinal lymph nodes.

1. EBUS for lung cancer diagnosis and staging

One of the most important uses of EBUS is mediastinal lymph-node staging in lung cancer.

Staging determines whether cancer has reached lymph nodes around the windpipe and major bronchi. This information can significantly affect treatment planning.

CT and PET-CT are extremely useful imaging tests, but abnormal lymph nodes on a scan do not automatically prove cancer.

A recent review reported approximate sensitivity and specificity for mediastinal staging of:

These figures vary between studies and patient populations and should not be interpreted as guarantees for an individual patient.

The advantage of EBUS is that it can provide an actual tissue diagnosis while also helping determine which lymph-node stations contain cancer.

In suitable cases, the same sample may provide material for additional pathology and molecular testing needed to guide modern lung-cancer treatment.

However, whether a particular EBUS sample is sufficient for every biomarker test depends on the quantity and quality of tissue obtained.

2. EBUS for tuberculosis and sarcoidosis

This is especially relevant in India because tuberculosis and sarcoidosis can produce very similar patterns of enlarged mediastinal or hilar lymph nodes.

CT or PET-CT alone may not reliably distinguish them.

EBUS-TBNA allows doctors to obtain lymph-node material that can be examined for granulomas and, when TB is suspected, sent for microbiological testing such as molecular tests and mycobacterial culture.

A meta-analysis involving 809 patients reported pooled sensitivity of about 80% for diagnosing intrathoracic tuberculosis using EBUS-TBNA.

EBUS is also useful in suspected sarcoidosis. An American Thoracic Society guideline found an overall diagnostic yield of approximately 87% for EBUS-guided lymph-node sampling in patients with suspected sarcoidosis who required tissue sampling.

An important caution is that finding granulomas does not automatically prove sarcoidosis.

Tuberculosis, fungal disease and several other conditions can also produce granulomatous inflammation. Clinical findings, microbiology, imaging and pathology therefore need to be interpreted together.

You can read more about this diagnostic overlap in our article on sarcoidosis in India.

3. EBUS for unexplained enlarged lymph nodes

Not every enlarged lymph node is caused by TB, sarcoidosis or primary lung cancer.

Other possibilities include:

• Lymphoma

• Metastatic cancer from another organ

• Other infections

• Reactive lymph-node enlargement

• Less common inflammatory disorders

EBUS may provide the diagnosis in many of these situations.

However, its usefulness varies by disease.

What about lymphoma?

EBUS-TBNA can diagnose some lymphomas, but a needle-aspiration sample is not always sufficient because lymphoma classification can require larger amounts of tissue and preservation of lymph-node architecture.

If lymphoma remains strongly suspected after an inconclusive EBUS-TBNA, doctors may recommend another biopsy method.

Newer EBUS-guided techniques that obtain larger tissue samples are increasingly being studied, but availability varies between centres. Recent evidence continues to show that standard EBUS-TBNA has limitations for lymphoma compared with techniques that obtain larger tissue fragments.

EBUS vs bronchoscopy: what is the difference?

A conventional flexible bronchoscope mainly allows the doctor to examine the inside of the airways.

An EBUS bronchoscope adds ultrasound, allowing the pulmonologist to see structures lying beyond the airway wall, particularly lymph nodes and masses.

For a broader explanation, see our bronchoscopy service.

EBUS vs PET-CT

PET-CT and EBUS answer different questions.

PET-CT shows how metabolically active different parts of the body are. It is very useful for cancer staging and deciding which areas require closer investigation.

But increased PET activity is not specific for cancer.

Tuberculosis, sarcoidosis and other inflammatory conditions can also show increased uptake.

Therefore, an active lymph node on PET-CT may still require tissue sampling before treatment decisions are made.

EBUS can provide that tissue when the lymph node is accessible from the airway.

EBUS vs CT-guided biopsy

A CT-guided needle biopsy is generally better suited to abnormalities located in the peripheral lung or close to the chest wall.

EBUS-TBNA is particularly useful for lymph nodes and masses adjacent to the major central airways.

The best biopsy method therefore depends on where the abnormality is located, not simply which test is newer.

Our guide to tests used to diagnose lung diseases explains how bronchoscopy, EBUS, CT-guided biopsy and other procedures fit into the diagnostic process.

EBUS vs mediastinoscopy

Mediastinoscopy is a surgical procedure performed under general anaesthesia in which a surgeon accesses mediastinal lymph nodes through an incision near the neck.

EBUS-TBNA reaches many important mediastinal and hilar lymph-node stations through the airway without a surgical incision.

For this reason, EBUS is now generally preferred as the initial invasive mediastinal staging procedure when the required lymph nodes are accessible.

That does not mean mediastinoscopy has become unnecessary.

Surgical sampling may still be considered when:

• EBUS is negative but the probability of malignancy remains significant

• The required lymph-node station cannot be adequately reached

• More tissue is needed

• Previous sampling was inadequate

• The clinical situation requires surgical confirmation

The decision depends on imaging, tumour characteristics, the quality of the EBUS examination and the consequence of potentially missing disease.

Who may need an EBUS test?

A pulmonologist may recommend EBUS if:

• A CT scan shows unexplained enlarged mediastinal or hilar lymph nodes

• PET-CT shows active lymph nodes requiring tissue confirmation

• Lung cancer requires lymph-node staging

• Tuberculosis involving intrathoracic lymph nodes is suspected

• Sarcoidosis is suspected and tissue confirmation is needed

• A central chest mass lies next to an accessible airway

• Another cancer may have spread to chest lymph nodes

Not every enlarged lymph node requires EBUS.

If there is an easier and safer site to biopsy, such as an accessible peripheral lymph node, doctors may choose that site first.

Likewise, if a diagnosis has already been established by a less invasive test and EBUS would not change management, the procedure may not be necessary.

What happens during an EBUS test?

The details vary between centres, but EBUS-TBNA commonly follows these steps.

1. Pre-procedure assessment

The doctor reviews your CT or PET-CT and decides which lymph nodes or masses should be sampled.

Tell the team about:

• Blood-thinning medicines

• Diabetes medicines or insulin

• Heart disease

• Lung disease

• Sleep apnea

• Previous problems with sedation or anaesthesia

• Medication allergies

Do not stop anticoagulants or antiplatelet medicines unless your treating doctor specifically instructs you to do so.

2. Fasting

You will be asked to fast before EBUS because sedative medicines can affect protective airway reflexes.

The exact fasting period depends on what you have eaten or drunk, the planned sedation or anaesthesia and the centre's protocol.

Indian bronchoscopy guidance uses different minimum fasting periods for clear liquids and food rather than one universal "no water for five hours" rule.

Jindal Chest's current EBUS information advises approximately five hours of fasting before its procedure, so patients having EBUS at the clinic should follow the specific instructions given by the treating team.

3. Local anaesthesia and sedation

Local anaesthetic is used to numb the airway.

EBUS-TBNA is usually performed with sedation. Indian EBUS guidelines state that it can be performed under either moderate sedation or deep sedation/general anaesthesia depending on the patient, procedure, expertise and facilities available.

4. The EBUS bronchoscope is inserted

The bronchoscope is usually passed through the mouth and into the windpipe.

The ultrasound probe is then used to identify lymph nodes, nearby blood vessels and other structures.

5. Needle samples are taken

A fine needle passes through the airway wall into the target lymph node or mass while its position is monitored on ultrasound.

Several passes may be required to obtain enough material.

Indian EBUS guidance recommends at least three passes per sampled lymph-node station in many situations and additional sampling when adequate material is needed for molecular profiling.

6. Recovery

After the procedure, you are monitored until your breathing, blood pressure and level of alertness are satisfactory.

Many patients having an uncomplicated outpatient EBUS can return home the same day.

If sedation has been used, an adult should generally accompany you home and you should follow the centre's instructions about driving and other activities.

How long does an EBUS test take?

At Jindal Chest Clinics, the current EBUS information states that the procedure generally takes approximately 30 to 40 minutes.

Actual procedure time can be shorter or longer depending on:

• How many lymph-node stations need sampling

• Whether systematic lung-cancer staging is required

• How easy the targets are to access

• Whether additional bronchoscopy procedures are performed

• The type of anaesthesia or sedation used

Allow additional time for preparation and recovery.

Is an EBUS test painful?

EBUS is usually not described as a painful procedure, but it can be uncomfortable.

Local anaesthetic and sedation are used to reduce coughing, gagging and discomfort.

You may experience:

• Coughing

• Throat irritation

• A feeling of pressure

• Temporary hoarseness

• Mild sore throat afterwards

Experiences vary between patients, so it is better not to promise that the procedure is completely painless.

Is EBUS safe?

EBUS-TBNA is generally considered a low-risk procedure when performed by appropriately trained teams.

Possible complications include:

• Temporary fall in oxygen level

• Bleeding

• Reactions to sedation

• Abnormal heart rhythm

• Low blood pressure

• Infection

• Pneumothorax, although this is uncommon with routine lymph-node EBUS-TBNA

A PGIMER study of 1,004 EBUS-TBNA/EUS-B procedures performed under bronchoscopist-directed conscious sedation found complications in 5.9% of patients, with most being minor and self-limiting.

Major complications occurred in 1.1%, and 0.8% required escalation to a higher level of care.

These figures come from one tertiary-care centre and should not be used to predict an individual patient's personal risk.

Risk varies according to medical condition, sedation, procedure complexity and the type of sampling performed.

What should you expect after EBUS?

After EBUS you may temporarily have:

• A sore throat

• Mild cough

• Hoarseness

• Small streaks of blood in sputum

• Tiredness from sedation

Do not eat or drink until your treating team confirms that your throat sensation and swallowing are safe.

If you received sedation, follow the unit's instructions about driving, alcohol, machinery and important decisions.

Seek medical advice promptly for increasing bleeding, significant breathlessness, severe or worsening chest pain, persistent fever or other symptoms your treating team has told you to watch for.

How long do EBUS results take?

There is no single result time because different samples require different laboratory tests.

Initial cytology or pathology may become available within several days.

Additional tests can take longer:

• Molecular cancer testing may require additional days or weeks

• TB molecular tests may be available earlier

• Mycobacterial culture and drug-susceptibility testing can take considerably longer

Ask the treating team which tests have been ordered and when each result is expected.

What does a positive EBUS result mean?

The meaning depends on what has actually been found.

For example:

• Malignant cells can establish a cancer diagnosis in the appropriate clinical setting

• Granulomas may support TB, sarcoidosis or another granulomatous condition but require clinical and microbiological interpretation

• A positive microbiological test may help establish infection

• Adequate benign lymphoid tissue may be reassuring in some situations but does not automatically exclude disease

There is therefore no single accuracy percentage that applies to every possible EBUS result.

What does a negative EBUS result mean?

A negative EBUS does not always mean that there is no disease.

Its significance depends on:

• Why the procedure was performed

• Which lymph nodes were sampled

• Whether all relevant lymph-node stations were assessed

• Sample adequacy

• Imaging findings

• The underlying probability of cancer or another disease

For lung-cancer staging, EBUS has a high negative predictive value in appropriately selected populations, but no biopsy test is perfect. A contemporary review reports an NPV around 91% in one staging context.

That does not mean that exactly one in eleven negative tests will be wrong for every patient.

Predictive values depend heavily on how common the disease is in the population being tested.

If imaging remains highly suspicious despite a negative EBUS, the multidisciplinary team may recommend further investigation such as repeat endoscopic sampling, another biopsy route or surgical staging.

Does needing an EBUS test mean I have cancer?

No.

EBUS is used to investigate several conditions that can enlarge chest lymph nodes, including:

• Tuberculosis

• Sarcoidosis

• Lung cancer

• Lymphoma

• Other cancers

• Infections

• Other inflammatory conditions

The purpose of obtaining a tissue sample is precisely to avoid assuming the diagnosis from imaging alone.

Can EBUS diagnose TB?

EBUS-TBNA can be very useful when tuberculosis involves mediastinal or hilar lymph nodes, particularly when a suitable sputum diagnosis is not available.

Samples can be examined under the microscope and sent for appropriate molecular and culture testing.

However, a negative EBUS sample does not completely exclude tuberculosis.

The diagnosis should be based on the full clinical, radiological, pathological and microbiological picture.

EBUS test kyun kiya jaata hai?

EBUS test seene ke andar windpipe ke paas maujood lymph nodes ya mass se sample lene ke liye kiya jaata hai.

Bronchoscope ke tip par ultrasound hota hai, jisse doctor lymph node aur aas-paas ki blood vessels ko screen par dekh kar needle se sample le sakta hai.

Iska use lung cancer ki diagnosis aur staging, chest lymph-node TB, sarcoidosis aur doosri conditions ki jaanch mein kiya ja sakta hai.

CT scan mein enlarged lymph node dikhne ka matlab automatically cancer nahi hota. EBUS ka purpose tissue lekar actual cause pata karna hota hai.

How should I prepare for an EBUS test?

Before your procedure:

• Follow the fasting instructions supplied by your centre

• Bring your CT or PET-CT images and reports

• Bring your medication list

• Tell the doctor about blood thinners

• Tell the doctor about diabetes medicines

• Mention previous anaesthesia or sedation problems

• Arrange for an adult to accompany you home if sedation is planned

Do not alter prescription medicines without instructions from your treating team.

What should I ask before having an EBUS?

Useful questions include:

1. Which lymph nodes or mass are you planning to sample?

2. What diagnoses are you considering?

3. Is this EBUS for diagnosis, cancer staging or both?

4. What type of sedation will I receive?

5. How long should I fast?

6. Do I need to change any regular medicines?

7. What tests will be performed on the sample?

8. What happens if the EBUS result is inconclusive?

9. When should I expect the results?

10. Will I need any additional biopsy if the result is negative?

Tissue can answer what a scan cannot

An enlarged or PET-active lymph node is a finding, not a final diagnosis.

Cancer, tuberculosis, sarcoidosis and other conditions can sometimes look similar on chest imaging.

EBUS allows many mediastinal and hilar lymph nodes to be sampled without an incision, which is why it has become an important part of modern interventional pulmonology.

If your CT or PET-CT shows enlarged chest lymph nodes, the right question is not simply whether you "need an EBUS", but whether obtaining tissue from those nodes is likely to change your diagnosis, staging or treatment.

Jindal Chest Clinics, Sector 20D, Chandigarh, provides EBUS, bronchoscopy and other advanced pulmonary diagnostic procedures.

Book an appointment to discuss your scan with the chest team.

Medical disclaimer: This article is intended for general education and does not replace professional medical diagnosis, advice or treatment. Diagnostic yield and complication figures describe groups of patients and cannot predict an individual's result. Follow the preparation, medication and aftercare instructions provided by your treating team.

Medical references

1. Joint Indian Chest Society and Indian Association for Bronchology. Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). Lung India. 2023.

2. American Thoracic Society. Clinical Practice Guideline for the Diagnosis and Detection of Sarcoidosis.

3. Dhooria S, Sehgal IS, Gupta N, et al. Diagnostic Yield and Complications of EBUS-TBNA Performed Under Bronchoscopist-Directed Conscious Sedation. Journal of Bronchology & Interventional Pulmonology. 2017.

4. Fiore C, Ayasa LA, Murn M, Swenson K. Comprehensive review of EBUS-TBNA: staging, techniques and future directions. Journal of Thoracic Disease. 2025.

5. Meta-analysis of EBUS-TBNA for intrathoracic tuberculosis.