Endobronchial ultrasound (EBUS)
A camera test that uses ultrasound from inside the airways to find and take samples from lymph glands and areas in the centre of the chest, often to investigate or stage lung cancer.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- EBUS uses ultrasound from inside the airways to find and sample lymph glands in the centre of the chest, often to diagnose or stage lung cancer.
- It is less invasive than a surgical operation, but it cannot always reach or sample every gland and may not give a firm answer.
- It is usually a day-case test under throat spray and sedation; if sedated you cannot drive, work or sign legal documents for 24 hours.
- Serious bleeding is uncommon (around 1 in 400), but you should be given clear warning signs and a contact number for afterwards.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Lets the doctor see and sample glands in the centre of the chest that an ordinary bronchoscopy cannot reach
You are too unwell or your oxygen levels are too low to tolerate the test safely without first being stabilised.
You are awake but drowsy from sedation (or asleep under general anaesthetic), with your throat numbed. Your oxygen and heart rate are monitored throughout.
Clear written instructions on what is normal, what is a warning sign (including chest infection and mediastinitis) and who to contact out of hours.
You are awake but drowsy from sedation (or asleep under general anaesthetic), with your throat numbed. Your oxygen...
You recover in a monitored area until the sedation wears off. You cannot eat or drink until the throat numbness...
Expect to feel tired. If sedated, do not drive, work, drink alcohol, use machinery or sign legal documents for 24...
A sore throat, hoarse voice, mild cough and small specks of blood in your spit can be normal. Watch for fever or...
What is endobronchial ultrasound (EBUS)?
Endobronchial ultrasound, or EBUS, is a test that combines a bronchoscopy with ultrasound. A bendy camera tube with a small ultrasound probe on the end is passed through your mouth and into your airways. The ultrasound lets the respiratory physician see lymph glands and other structures that sit just outside the airways, in the centre of the chest, which an ordinary bronchoscopy cannot reach.
Using the ultrasound picture to guide them, the doctor passes a fine needle through the wall of the airway to take samples of cells from these glands. This is called transbronchial needle aspiration, or TBNA.
EBUS is most often used to investigate enlarged lymph glands, to help diagnose conditions such as lung cancer or sarcoidosis, and to work out how far a lung cancer has spread (called 'staging'). It has become a less invasive alternative to a surgical operation called mediastinoscopy.
Like all tests, EBUS does not always give a firm answer, and a small or hard-to-reach gland may not be sampled successfully. This guide explains what to expect so you can ask better questions; it is not personal medical advice.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
EBUS compared with mediastinoscopy
| Point | EBUS | Mediastinoscopy |
|---|---|---|
| How it is done | Camera and needle through the airway | Surgical cut at the base of the neck |
| Anaesthetic | Throat spray and sedation, or general | General anaesthetic |
| Stay | Usually day case | Often an overnight stay |
| Glands reached | Many, but not all | Some that EBUS cannot reach |
EBUS is often tried first because it is less invasive. A surgical biopsy is sometimes still needed if EBUS cannot reach a gland or does not give an answer.
Preparing for your procedure
- You will usually be asked not to eat for about 6 hours before, with clear fluids until about 2 hours before — follow your unit's exact times.
- Tell the team about all your medicines, especially blood thinners such as warfarin, aspirin, clopidogrel, apixaban, rivaroxaban, edoxaban or dabigatran. Some people need a temporary change before this procedure, but the plan differs by medicine, the exact procedure and their risk of bleeding or blood clots. Do not stop, skip or restart any of these medicines unless the team responsible for your procedure gives you specific instructions.
- Ask for clear instructions about diabetes medicines, which often need adjusting on the day of the test.
- Mention any heart or lung condition, allergies, or previous reaction to sedation or anaesthetic.
- Arrange for a responsible adult to take you home and, ideally, stay with you overnight after sedation.
- Plan not to drive, work, drink alcohol or sign legal documents for 24 hours after sedation.
- Bring your inhalers and an up-to-date list of your medicines.
What happens
You are usually awake but relaxed with sedation, although some units use a general anaesthetic. Local anaesthetic is sprayed onto your throat and given through the bronchoscope, and a sedative is given through a cannula in the back of your hand. Your oxygen level and heart rate are monitored throughout, and you are given oxygen.
The ultrasound bronchoscope is passed gently through your mouth and into your airways. The doctor uses the ultrasound probe to find the lymph glands, then passes a fine needle through the airway wall to take cell samples. The needle sampling is generally not painful. Several glands may be sampled, sometimes with a scientist checking the samples in the room.
The test usually takes about 45 minutes to an hour. Afterwards you recover in a monitored area until the sedation wears off and your throat is no longer numb, usually for about 1 to 2 hours before going home.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You are too unwell or your oxygen levels are too low to tolerate the test safely without first being stabilised.
- You have a bleeding tendency or are on blood thinners that cannot be safely paused.
- An uncontrolled heart rhythm problem or recent heart attack means the risk currently outweighs the benefit.
- The glands that need sampling cannot be reached by EBUS, so a surgical biopsy is more appropriate.
Delay or rearrange if…
- You have an active chest infection or are acutely wheezy, until this is treated and more stable.
- Your blood thinners have not been managed according to a clear plan.
- Your asthma or COPD is poorly controlled and could be optimised first.
- You cannot arrange a responsible adult to take you home after sedation.
- There is a chance you could be pregnant and this has not been discussed.
Alternatives to discuss
- A PET-CT or CT scan, which can show glands but cannot sample them
- A standard bronchoscopy if only the airways need looking at
- Mediastinoscopy or other surgical biopsy for glands EBUS cannot reach
- A CT-guided lung biopsy for lesions in the outer lung
- Watchful waiting with repeat imaging for low-risk findings, if your team advises
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Lets the doctor see and sample glands in the centre of the chest that an ordinary bronchoscopy cannot reach
- Helps diagnose the cause of enlarged glands, such as cancer, sarcoidosis or infection
- Helps stage lung cancer accurately so the right treatment can be chosen
- Is less invasive than a surgical operation such as mediastinoscopy
- Can often avoid a bigger operation if it gives a clear answer
Risks & complications
- A sore throat or hoarse voice for a day or two
- Coughing during and for a short time after the test
- Coughing up small amounts of blood for a few hours
- Feeling tired or drowsy for several hours from the sedation
- Significant bleeding (around 1 in 400 people)
- A drop in oxygen level or an irregular heartbeat during the test
- A chest infection needing antibiotics
- The fine needle occasionally breaking (less than 1 in 100 people)
- Worsening of breathing, particularly in people with asthma or COPD
- A collapsed lung (pneumothorax)
- Infection or inflammation in the centre of the chest (mediastinitis)
- An allergic reaction to the sedative or anaesthetic
- Death (recorded in around 1 in 10,000 procedures, mainly in people who are already very unwell)
The main things that raise your risk are existing heart or lung disease and any tendency to bleed, so be honest about every medicine you take, especially blood thinners. Mediastinitis (infection in the centre of the chest) is rare but important, and can appear in the days after the test. Ask your respiratory physician how many glands they plan to sample, what your personal risk is, and exactly what warning signs to watch for afterwards.
Published figures to discuss
EBUS is generally well tolerated, but the chance of a problem depends on your heart and lung health, any bleeding tendency, and how many glands are sampled. The rates below come from NHS patient information and UK guidance and are cautious, broad figures rather than a precise prediction for you.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Significant bleeding | Around 1 in 400 people | More likely in people on blood thinners. Coughing up small specks of blood for a few hours is common and not the same thing. | University Hospitals Sussex NHS FT — Having an endobronchial ultrasound (EBUS)uhsussex.nhs.ukPublished figure |
| Needle breakage during sampling | Less than 1 in 100 people | Uncommon and usually managed at the time. | University Hospitals Sussex NHS FT — Having an endobronchial ultrasound (EBUS)uhsussex.nhs.ukPublished figure |
| Serious complication (significant bleeding, lung collapse or similar) | Roughly 1–5 in 1000 procedures | Includes pneumothorax, infection and breathing or heart problems; more likely with existing heart or lung disease. | University Hospitals Sussex NHS FT — Having an endobronchial ultrasound (EBUS)uhsussex.nhs.ukSource-linked context |
| Death | Around 1 in 10,000 procedures | Mainly in people who are already very unwell. Very rare, but it is why the test is only done when justified. | University Hospitals Sussex NHS FT — Having an endobronchial ultrasound (EBUS)uhsussex.nhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no wound to heal, but you will need a few hours to recover from the sedation and numb throat, and the detailed laboratory testing of the samples means results usually take a couple of weeks.
- A sore or scratchy throat and a hoarse voice for a day or two
- Coughing up small specks of blood for a few hours
- Feeling drowsy and forgetful for the rest of the day after sedation
- Mild tiredness as the sedation fully wears off
- Waiting a couple of weeks for results, which can feel anxious — especially if cancer is being investigated
Aftercare
- Do not eat or drink until the numbness in your throat has fully worn off.
- Have a responsible adult take you home and stay with you if you were sedated.
- Rest for the remainder of the day and avoid alcohol for 24 hours.
- Soothe a sore throat with sips of water, lozenges or simple pain relief such as paracetamol if needed.
- Take your usual inhalers and medicines as advised, and ask when to restart any blood thinners that were stopped.
- Watch for warning signs such as fever, chest pain or breathlessness in the days afterwards.
- Keep your follow-up appointment, and save the unit's out-of-hours contact number.
- Someone booked to drive you home and stay over if sedated
- Day off work and no driving planned for 24 hours after sedation
- Fasting instructions and timings understood
- Plan agreed for stopping and restarting blood thinners
- Inhalers and medicines list packed
- Unit and out-of-hours contact number saved
- Follow-up appointment for results noted
⚠ Get urgent help if…
- Coughing up more than small specks of blood, or larger amounts of fresh blood
- Increasing breathlessness or chest tightness
- Sharp or worsening chest pain, especially in the centre of the chest
- A high fever, shivering or feeling very unwell (possible infection, including mediastinitis)
- A fast, pounding or irregular heartbeat
- Difficulty swallowing or a severe, worsening sore throat
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
EBUS samples are sent for detailed laboratory testing, which is why a firm result usually takes a couple of weeks rather than being available on the day. A positive sample can confirm a diagnosis such as cancer or sarcoidosis and, in cancer, show how far it has spread.
A negative or inconclusive sample does not always rule a diagnosis out, because a small or hard-to-reach gland may not have been sampled fully. In that situation a repeat test or a surgical biopsy is sometimes needed. Your respiratory physician will explain what your result means, what it cannot prove, and the next step.
EBUS gives a picture of your glands at one point in time. If your situation changes or a result is unclear, the test may need to be repeated or followed by another procedure. In cancer staging, the findings guide treatment decisions but may be reviewed alongside other scans and tests.
Related tests, treatments or support
EBUS is usually planned alongside a CT or PET-CT scan and is often combined with a standard bronchoscopy in the same sitting. If it cannot reach a gland or does not give an answer, a surgical biopsy such as mediastinoscopy or a CT-guided lung biopsy may be considered.
Follow-up & long-term care
Results are usually explained at a follow-up appointment, often within 2–3 weeks and frequently as part of a specialist lung cancer or respiratory clinic. You should be told who is coordinating your care, who to contact if results are delayed, and what to do if you develop warning signs.
Repeat, follow-on and what comes next
- A negative or unclear sample does not always rule out disease, as a gland may not have been fully sampled.
- A repeat EBUS or a surgical biopsy such as mediastinoscopy is sometimes needed.
- In cancer staging, findings are reviewed alongside scans and may change the plan as more information arrives.
- Detailed laboratory testing takes time, so the full picture is rarely clear on the day.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written instructions on what is normal, what is a warning sign (including chest infection and mediastinitis) and who to contact out of hours.
- A named route back to the respiratory or lung cancer team if you become unwell.
- A defined plan and appointment for explaining your results, with a contact if they are delayed.
- A clear plan for restarting any blood thinners that were stopped.
- Prompt onward referral and support, including a clinical nurse specialist, if a serious diagnosis is found.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the test is done under sedation or general anaesthetic, and the monitoring needed
- The respiratory physician's fee and the endoscopy unit or facility fee
- How many lymph gland stations are sampled and the number of samples sent
- Laboratory and pathology charges, including any rapid in-room sample checking
- Whether a standard bronchoscopy or other techniques are done in the same sitting
- A follow-up appointment to discuss results, and any further tests if the result is inconclusive
- The respiratory physician's fee and the endoscopy or facility fee
- Sedation or general anaesthetic and monitoring costs
- Laboratory and pathology fees for all gland samples taken
- The cost of the follow-up appointment to explain your results
- What happens, and what it costs, if the result is inconclusive and needs a repeat or surgical biopsy
- The cancellation policy and what is covered if a complication needs treatment
On the NHS? EBUS is a standard NHS test, often within specialist lung cancer pathways; private access is mainly used for speed, choice of consultant or a second opinion rather than because the NHS does not provide it.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told that EBUS cannot reach every gland and may not give a firm answer.
- Sedation or general anaesthetic and 24-hour driving and work restrictions not being made clear in advance.
- Blood thinners not being properly reviewed before the test.
- No clear written warning signs (including for mediastinitis) or out-of-hours contact for after you go home.
- Not being told who is coordinating your care and when results will be explained.
Marketing red flags
- Describing EBUS as a 'quick, simple scan' without mentioning sedation, needle sampling, recovery and warning signs.
- Implying a negative result completely rules out cancer.
- Promising rapid results when detailed laboratory testing takes days to weeks.
- Not explaining when a surgical biopsy would still be needed.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Why do I need EBUS, and is it to diagnose a problem, to stage a cancer, or both?
- How many glands do you plan to sample, and what is my personal risk of bleeding or other problems?
- Will I have sedation or a general anaesthetic, and what does that mean for getting home?
- What happens if the samples do not give a clear answer — would I need a surgical biopsy?
- Who will explain my results, when, and who do I contact if I develop warning signs?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is EBUS available on the NHS?
Does the needle sampling hurt?
Will I be awake?
When will I get my results?
What if EBUS cannot reach the gland?
Is EBUS better than an operation?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: University Hospitals Sussex NHS FT — Having an endobronchial ultrasound (EBUS) Imperial College Healthcare NHS Trust — Endobronchial ultrasound (EBUS) Roy Castle Lung Cancer Foundation / NHS England — EBUS-TBNA service specification British Thoracic Society — Advanced diagnostic and therapeutic flexible bronchoscopy guideline Cancer Research UK — Bronchoscopy
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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