Dr Navani’s expertise
Ultrasound image taken by an EBUS bronchoscope showing a needle taking a biopsy of the lymph node indicated
Only around 25 centres in the UK have the equipment and expertise to offer endobronchial ultrasound. Dr Navani played an important role in setting up the tertiary endobronchial ultrasound referral service at UCLH in 2007.
As Lead Clinician, Neal has developed and refined a high-quality and fast-turnaround service that has a reputation for excellence in terms of treating patients and for its contribution to advancing research.
Neal has now performed over two thousand separate endobronchial ultrasound procedures and is one of the most experienced EBUS consultants in Europe. Endobronchial ultrasound is now available for private patients through Dr Navani’s practice at the King Edward VII Hospital.
Endobronchial ultrasound and bronchoscopy
Schematic diagram showing the field of view visible to an EBUS bronchoscope
A standard bronchoscopy can reveal obvious problems such as inflammation or tumours inside the airways, but it cannot show what is going on deeper within the tissues. An endobronchial ultrasound (EBUS) is performed during a bronchoscopy, but with a specially designed bronchoscope.
Tip of an EBUS scope
An EBUS bronchoscope has the usual light and camera, but it also contains a tiny integral ultrasound scanner within the tip of the endoscope.
This transmits ultrasound waves into the lungs, heart and tissues nearby, picks up the ‘reflections’ and puts this information together to produce a detailed image of the inside of the chest.
The images are sent straight to a screen so that the consultant can look in detail at any enlarged lymph nodes or suspicious areas.
The endobronchial ultrasound scan can also act as a guide to allow the consultant to take a very accurate needle biopsy if required.
Why might you need an endobronchial ultrasound?
You will be referred for an endobronchial ultrasound by another respiratory medicine specialist to investigate:
- Lymph nodes in your chest that appear larger than normal in a CT scan. This is a common finding and always needs to be investigated.
- Symptoms that may suggest you have tuberculosis or sarcoidosis. Both produce scarring, known as fibrosis, in the lungs. An EBUS can be used to guide an internal biopsy and so obtain a firm diagnosis.
- A tumour in the lung tissue or the airways. An endobronchial ultrasound is an important diagnostic tool for lung cancer, and it can also be used to stage cancer. The scan results can show whether a tumour has spread to the chest lymph nodes, and how large it has grown.
Why is an endobronchial ultrasound a medical advance?
Before EBUS became possible, investigations could only be carried out using numerous scans in combination with an exploratory operation. The lymph nodes in the chest are quite inaccessible, so this meant quite a serious surgical procedure, a couple of days in hospital and then a couple of weeks recovery time. Not only is an endobronchial ultrasound fast – it takes about 30-40 minutes – it is much less invasive. You only need light sedation and you are fine to return home two hours after the test is completed and to normal activities the next day.
Having an EBUS
An endobronchial ultrasound is done as a day case. Most patients have a relaxing sedative, but it is possible to tolerate the bronchoscope with no sedation and you can then go straight back to work or drive home safely.
- The back of your throat is sprayed so that it is completely numb to make it more comfortable when the bronchoscope is introduced through the throat and into the trachea (windpipe).
- We monitor your blood pressure and your oxygen levels throughout and sometimes give you some oxygen through small tubes that sit at the base of your nose.
- When the bronchoscope reachers the trachea you will cough for about 20 seconds as this is a normal reflex, but your breathing will be normal and the urge to cough passes quickly.
- If you choose to have a sedative, this will be topped up as required so that you are very drowsy and relaxed throughout.
- A general anaesthetic for the procedure can also be arranged.
Your endobronchial ultrasound results
After reviewing your scan images and after obtaining any biospy findings, Dr Navani will arrange a consultation to discuss your diagnosis and treatment plan.
Want to find out more?
Detailed information on having a bronchoscopy is available from the British Thoracic Society.
Dr Navani has written a detailed article for Total Health: Diagnosing lung and chest conditions using Endobronchial Ultrasound (EBUS)