This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Sheski, F. D. Articles by Mathur, P. N. Search for Related Content PubMed PubMed Citation Articles by Sheski, F. D. Articles by Mathur, P. N. Related Content Topics in Practice Management

Endobronchial Ultrasound

^* From Indiana University School of Medicine, Indianapolis, IN.

Correspondence to: Praveen N. Mathur, MBBS, FCCP, Indiana University Hospital, 550 N University Blvd, Suite 4903, Indianapolis, IN 46202; e-mail: pmathur{at}iupui.edu

Abstract

During flexible fiberoptic bronchoscopy (FB), a solitary pulmonary nodule (SPN) is sampled by means of transbronchial needle aspiration (TBNA), brush, or transbronchial lung biopsy under fluoroscopy; and mediastinal lymph nodes are sampled using "blind" TBNA. Endobronchial ultrasound (EBUS) was developed to help visualize the lesion at the time of biopsy in order to improve the diagnostic yield.

Methods: There are two types of EBUS techniques: using a radial probe (RP) with a rotating transducer at the distal tip, which produces a 360° image to the long axis of the bronchoscope; and using an EBUS bronchoscope with a linear transducer at its distal tip, producing a 50° image parallel to its long axis.

Results: In biopsies of SPNs < 2 cm using an RP, EBUS demonstrates a higher diagnostic yield than conventional FB techniques. With mediastinal and hilar nodal stations, except for the subcarina, EBUS shows a higher yield over blind TBNA. The current procedural terminology code for EBUS is 31620, a "ZZZ" code submitted in addition to other performed procedures (31622–31638). In 2007, an estimate of physician Medicare reimbursement for EBUS is $70.49. Reimbursement is locality dependent and based on economic-exchange conversion factors. Incorporating an ultrasound image into the report substantiates the use of this technique.

Limitations: The physician must learn ultrasound image interpretation and the EBUS technique, and be skilled in TBNA. Maintaining competency requires frequent performance of EBUS.

Conclusion: EBUS-directed biopsy improves the yield over conventional FB for SPNs < 2 cm and for most mediastinal or hilar nodal stations. This reduces the need to conduct additional diagnostic procedures.

Key Words: bronchoscopy • endobronchial ultrasound • interventional pulmonology

This article has been cited by other articles:

				S. Manaker, A. Ernst, and L. Marcus Affording Endobronchial Ultrasound Chest, April 1, 2008; 133(4): 842 - 843. [Full Text] [PDF]