On endobronchial ultrasound (EBUS) and endoscopic ultrasound, characteristic findings of non-small cell lung cancer include enlarged lymph nodes and local invasion to adjacent bronchial structures and mediastinum. Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.

Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.^[1][2]

• Endobronchial and endoscopic esophageal ultrasound are mainly used to identify mediastinal metastasis.
• On ultrasound (endobronchial/endoscopic esophageal ultrasound), characteristic findings of non-small cell lung cancer include:
  • Enlarged lymph nodes
  • Local invasion of adjacent bronchial structures and mediastinum
• Indications for the endobronchial ultrasound:
  • Evaluation of lymph nodes and other structures in the mediastinum
  • Mediastinal invasion staging
  • Plan for management
  • Real-time evaluation of structures

The table below summarizes the advantages and disadvantages of both ultrasound modalities, for the diagnostic assessment of non-small cell lung cancer.

Procedure	Advantages	Disadvantages
Endobronchial ultrasound (EBUS)	Direct visualization of lymph node stations. Complements endoscopic ultrasound: covers lymph node stations 2R and 4R which are difficult to access by endoscopic ultrasound Lower false-negative rate than with blind transbronchial fine needle aspiration and fewer complications	More invasive than endoscopic ultrasound, few practitioners, but rapidly growing in popularity
Endoscopic ultrasound (EUS)	Least invasive modality Uses the esophagus to access mediastinal lymph nodes Excellent for staging lymph node metastases Useful for station 2L and 4L, L adrenal, celiac lymph node	Cannot reliably access right sided paratracheal lymph node stations 2R and 4R Accurate discrimination of primary hilar tumors and involved lymph nodes is important

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