EBUS-TBNA needles are primarily used to harvest tissue specimens from paratracheal lymph nodes (Station 2R/2L, 4R/4L), subcarinal nodes (Station 7) and hilar nodes (Station 10–12). Guidelines issued by the International Association for the Study of Lung Cancer (IASLC) endorse it as the first-line modality for preoperative staging of non-small cell lung cancer (NSCLC).

Beyond lung cancer, it delivers adequate tissue for pathological examination, immunohistochemistry and microbial culture in cases of unexplained mediastinal masses, sarcoidosis, tuberculous lymphadenitis, lymphoma and even thymic neoplasms.

The 19G large-bore needle (outer diameter 1.06 mm) yields larger tissue cores compared with conventional 21G/22G needles, facilitating molecular testing (e.g., EGFR, ALK, PD-L1 expression) to meet precision medicine requirements.

Operators advance a bronchoscope fitted with an ultrasound probe into the airway, identify lymph nodes and assess blood flow via real-time sonography. After target confirmation, the EBUS-TBNA needle is extended through the instrument channel and punctured into the lymph node center under ultrasonic guidance.

The needle's back-cut tip and laser-etched micro-textures render the apex distinctly visible on ultrasound, allowing operators to adjust angles to evade blood vessels. A negative-pressure syringe is then attached; the inner stylet is reciprocated 10–15 times to shear tissue. The needle is withdrawn afterward, and specimens are expelled into fixative or cell preservation solution.

The whole procedure takes an average of 15–20 minutes without general anesthesia, and patients can be discharged immediately post-procedure.

Meta-analyses demonstrate that EBUS-TBNA achieves a sensitivity of 89%–93% and near-100% specificity for mediastinal staging of lung cancer. False-negative results mostly stem from micrometastases or necrotic tissue. Rapid on-site evaluation (ROSE) instantly verifies specimen adequacy, with repeat puncture performed if needed.

The complication rate is extremely low (<1%), including mild hemoptysis, pneumothorax or infection, far lower than the 2%–5% rate associated with mediastinoscopy. A retrospective study enrolling 5,000 patients reported no severe hemorrhage or mortality. Accordingly, the American College of Chest Physicians (ACCP) grades EBUS-TBNA as Level IA evidence.

Traditional mediastinoscopy demands general anesthesia with a ~2 cm cervical incision and 1–2 days of postoperative hospitalization. By contrast, EBUS-TBNA accesses lesions via natural orifices (oral cavity) with no cutaneous wounds, enabling patients to resume regular diet the same day.

More crucially, EBUS can inspect bilateral mediastinal and hilar nodes simultaneously-regions left hilar nodes are often inaccessible to standard mediastinoscopy-and sample multiple nodal stations in a single session. For central tumors, EBUS-TBNA can directly puncture the primary lesion, integrating diagnosis and staging in one intervention.