# Endobronchial Ultrasound Access to Pulmonary Vasculature in Thoracic Malignancy

## TL;DR

Endobronchial ultrasound (EBUS) is being used to examine lung blood vessels and diagnose thoracic tumors, offering new diagnostic and treatment options.

## Contribution

This paper systematically reviews EBUS's expanding role in assessing pulmonary vasculature and diagnosing thoracic malignancies.

## Key findings

- EBUS can visualize major thoracic vessels and detect pulmonary embolism and endovascular lesions.
- EBUS-guided transvascular needle aspiration allows sampling of lesions behind vessels with low complication rates.
- Despite limitations like image quality, EBUS shows promise as a key tool in thoracic diagnostics.

## Abstract

Endobronchial ultrasound (EBUS) is currently used for far more than just diagnosing and staging lung cancer. It can also help physicians assess thoracic vasculature, such as the aorta and pulmonary arteries. With EBUS we can identify pulmonary embolism or non-thrombotic vascular lesions and acquire trasnsvascular access to lung tumors, while even intravascular lesions like artery sarcoma become approachable. Although EBUS is generally safe, related to very rare complications, more research is needed to confirm its reliability for thoracic vasculature exploration and to identify potential risks.

Endobronchial ultrasound (EBUS) has evolved beyond conventional applications in mediastinal staging and central pulmonary tumor diagnosis. It encompasses the assessment of pulmonary vasculature in patients with thoracic malignancies. EBUS can visualize major vessels and allow assessment of pulmonary embolism, differential diagnosis of endovascular lesions, and T staging. Additionally, EBUS-guided transvascular needle aspiration (TVNA) has proven valuable for sampling lesions behind vessels and diagnosing conditions such as pulmonary artery sarcoma and tumor embolism, with low complication rates reported. The PubMed and SCOPUS databases were searched up to November 2024 for articles in the English language reporting the use of EBUS for pulmonary vasculature assessment. References were also searched for relevant articles. The integration of EBUS with other modalities enhances staging and diagnostic capabilities in thoracic malignancies. Despite promising findings, limitations include suboptimal image quality and challenges in extensively assessing all the vasculature. Safety concerns, particularly with transvascular biopsy, remain minimal with expert handling, although further studies are needed to assess specific risks like hematogenous tumor seeding. EBUS continues to evolve, suggesting its potential to become the cornerstone in advanced thoracic diagnostics and treatment planning. This review systematically explores the feasibility, safety, and diagnostic utility of EBUS in pulmonary vasculature assessment, highlighting its potential as an indispensable tool in thoracic diagnostics and treatment planning.