Recent Updates on Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration and Its Clinical Implications

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard minimally invasive method for mediastinal staging in non-small cell lung cancer. As the tumor, node, metastasis (TNM) classification evolves with more refined prognostic stratification of N2 substages, accurate mediastinal evaluation has become increasingly critical. Beyond conventional staging, recent advances have significantly expanded the clinical utility of EBUS-TBNA. This review explores six key areas of development: evidence supporting systematic over targeted mediastinal sampling and the potential to omit confirmatory mediastinoscopy after negative EBUS-TBNA; the role of endoscopic ultrasound in accessing paraesophageal and inferior mediastinal stations; expanded procedural capabilities with third-generation thin scope EBUS; novel tissue acquisition devices, including the 19-gauge needle, mini forceps, and mediastinal cryobiopsy; considerations for tissue adequacy in next-generation sequencing; and image-based adjunctive tools such as elastography and artificial intelligence-driven sonographic analysis. Collectively, these developments underscore the growing role of EBUS-TBNA as a comprehensive diagnostic platform in thoracic oncology, extending its utility from mediastinal staging to peripheral lesion access, molecular profiling, and image-guided decision support.