New pilot audit of Endobronchial Ultrasound (EBUS) dataset finds data collection at scale is feasible

EBUS is a cornerstone of lung cancer care and featured heavily in the 2022 National Lung Cancer GIRFT Report recommendations to improve outcomes for lung cancer patients.

A deep-dive data analysis identified ‘marked and apparently unwarranted variation’ in the use of EBUS nationally. Given the variation in practice and performance, there is a need for monitoring and quality improvement against established standards, as offered by a BTS national audit. This would provide an opportunity to evaluate and benchmark a diagnostic test that has transformed bronchoscopy in the UK, subjecting it to a national quality assurance process. 

Key findings from the audit: 

• Data collection is scalable, with 28 hospitals submitting nearly 1,900 procedures.
• Diagnostic sensitivity was high at 91%, but only 84% provided adequate tissue for biomarker testing.
• No Trust met the 5-day timeliness target.
• Systematic staging was performed in 80% overall but with significant variation between hospitals.
• 20% of staging EBUS lymph node samples were inadequate.
• Use of rapid on-site cytology evaluation (ROSE) was rare (4%).
• Performance in non-lung cancer conditions was mixed: strong for sarcoidosis and metastatic cancer, but poor for tuberculosis and lymphoma.
• Variation between centres across almost all metrics suggests inequity of access to high-quality EBUS services. 

Professor Richard Russell, Chair of the British Thoracic Society, said:

“EBUS is an essential tool used to diagnose lung cancer. The newly completed national pilot audit into EBUS services has shown both real strengths and worrying inconsistencies in care. The message is clear: while EBUS is a powerful diagnostic tool, patients aren’t receiving the same standard of care everywhere. This variation is more than a statistic — it’s an equity issue, and one that demands focused improvement and urgently needs to be addressed with an increase in resource. This will enable patients to receive the best possible care for lung cancer and contribute to better outcomes.” 

Audit Co-Lead and author of the report, Dr Emma O’Dowd said: 

“The pilot shows that standardised, high-quality EBUS data collection is achievable across a wide range of UK centres. It highlights areas of excellent practice but also areas of variation and challenge, including standards where no site met the benchmark. The full national BTS audit planned for 2026 will allow us to explore this in depth and support centres to learn from one another.” 

The findings of this pilot audit highlight the need for a full national audit to benchmark services, identify outliers, and promote best practice. Improving timeliness, tissue adequacy, systematic staging, and equity of provision will be critical to ensure that all patients benefit equally from high-quality EBUS. 

Following the successful pilot of this audit, this will be rolled out nationally in 2026 to help provide a more comprehensive assessment of EBUS across the UK. 

Read the EBUS Pilot Audit Report