Narrative review of tools for endoscopic ultrasound-guided biopsy of mediastinal nodes

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has revolutionized the diagnosis and staging of lung cancer. Multiple studies support EBUS as a safe, cost-effective, and accurate method of diagnosing lung cancer. Even with the groundbreaking developments of immunotherapy and targeted therapy in advanced non-small cell lung cancer, EBUS-TBNA remains the optimal method for obtaining tissue for molecular testing. Since the advent of EBUS, there have been a multitude of needles and biopsy tools that have been developed, each with its own unique features that may make it suitable for various clinical situations. With needle sizes ranging from 19 gauge to 25 gauge, and both aspiration and biopsy needles, as well as mini-forceps available, there are now numerous tools to choose from. Over the past several years, EBUS has also gained new roles outside the realm of lung malignancy. EBUS now plays an important role in diagnosing other thoracic pathology, such as sarcoidosis and lymphoma, as well as facilitating treatment of both benign and malignant disease. As the use of EBUS has become more widespread, new tools have emerged to allow for EBUS to continue expanding its applicability. This review examines the evidence for the current equipment and novel tools that are being used in EBUS-guided biopsy.