Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

Puri, Rajesh; Vilmann, Peter; Sud, Randhir; Kumar, Mandhir; Taneja, Sunil; Verma, Kusum; Kaushik, Neeraj

doi:10.1055/s-0029-1244133

Cited by 62 publications

(55 citation statements)

References 13 publications

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“…Of the remaining 18 cases, 14 were nevertheless treated for tuberculosis based on clinical and cytological findings, while in 4 cases a mediastinoscopy was performed. The diagnostic accuracy, sensitivity and specificity of EUS-FNA in this study were respectively 93%, 71% and 100% (55).…”

supporting

confidence: 47%

“…Another indication of EUS-FNA is the diagnosis of mediastinal masses and benign granulomatous lymphadenopathy, e.g. tuberculosis (20)(21)(22), and sarcoidosis, with a sensitivity in the detection of lymph nodal non-necrotizing granulomas of about 87% (23). The contraindications to EUS-FNA are fundamentally represented by a status of known current bleeding or obstruction of the esophagus, and the suspicion that the lesion to be sampled is a cystic lesion, because of the high risk of infection and mediastinitis in these cases (24,25).…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

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Transesophageal endoscopic ultrasound (EUS) in pulmonary medicine

Romagnoli¹

2013

SOB

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SummaryEndoscopic ultrasound (EUS) is a safe and minimally invasive procedure, allowing ultrasound-guided needle aspirates in real-time, with high-sensitivity diagnostics. EUS is an instrument available to the pulmonologist for the diagnosis of mediastinal neoplasms, benign and malignant, including the mediastinal lymph node staging of non-small cell lung cancer (NSCLC), with a specific sensitivity up to 90%. EUS allows to detect and to sample even small lesions with a diameter of 3 mm, which are not visible at usual imaging. The most recent guidelines on mediastinal nodal staging of lung cancer report endoscopic and transbronchial ultrasound (EUS and EBUS) as a viable and valid minimally invasive alternative to the "classical" surgical staging with mediastinoscopy, resulting in significant savings in diagnostic invasive surgical procedures, and unnecessary thoracotomy, with a consequent high economical impact. EUS-FNA, as EBUS-TBNA, has been shown to be able to give in one time the diagnosis, the typing, staging, and genotyping of lung cancer with a single diagnostic procedure. However, it must be highlighted that in the mediastinal nodal re-staging of NSCLC, the sensitivity of EUS-FNA significantly decreases, being <50%. Therefore, in all cases of negativity at the re-staging a surgical mediastinoscopy should be performed before therapeutical decisions. EUS should be performed in referral centres, so patients should be referred to centres of reference for a complete endoscopic staging with EBUS/ EUS. All patients, except those with a known pathologic esophageal stenosis, might be investigated by EUS, even on an outpatient basis, in mild sedation with midazolam, or deep sedation with anaesthesia care based on the internal structure organization, and complications are very rare.

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supporting

confidence: 47%

Section: Indications and Contraindicationsmentioning

confidence: 99%

Transesophageal endoscopic ultrasound (EUS) in pulmonary medicine

Romagnoli¹

2013

SOB

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“…In published data, AFB detection ranged from 0.8% to 48.5%, while culture positivity ranged from 20% to 62% (10)(11)(12)(13)(14)(15)(16)(17). When these results are compared with fineneedle aspiration results for peripheral lymph nodes and EUS studies for mediastinal lymph nodes, sensitivities and specificities are similar (2,(18)(19)(20)(21). As a result, conventional microbiological methods have low diagnostic sensitivity for the diagnosis of MTLA, mostly due to a low burden of bacilli and insufficient sample amount (22).…”

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal tuberculous lymphadenitis

Erer¹,

Erol²,

Anar³

et al. 2017

Turk J Med Sci

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“…The diagnostic yield was found to be 90-93% [17,18]. Songür et al sampled celiac lymph nodes by EUS-FNA and detected acid-fast bacilli [19].…”

Section: Discussionmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.

et al. 2015

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Aims: Patients with suspected tuberculosis without pulmonary lesions and with intrathoracic lymphadenopathy often pose a diagnostic challenge. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isolated intrathoracic lymphadenopathy due to tuberculosis (TB). Materials and methods: Cases with tuberculous lymphadenitis (TBLA) as the final diagnosis were analysed among patients in whom EBUS-TBNA had been performed. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, pathological findings, and microbiological results were recorded. All patients received 6-month antituberculous treatment, followed-up regularly and recovered both on clinical and radiological basis. Results: Fourty-four patients were included. EBUS-TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4%) patients. In 2 patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7%) patients. One of the patients (2.2%) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50%) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation has improved the diagnostic yield from 72.7% to 95.4%. Conclusion: EBUS-TBNA is a safe and effective first line investigation for evaluating isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of EBUS-TBNA.

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Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

Abstract: EUS-FNA is an accurate, safe, and minimally invasive modality for evaluating isolated mediastinal lymphadenopathy in patients suspected of having tuberculosis in an endemic area with a high prevalence of tuberculosis.

Cited by 62 publications

References 13 publications

Transesophageal endoscopic ultrasound (EUS) in pulmonary medicine

Transesophageal endoscopic ultrasound (EUS) in pulmonary medicine

The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal tuberculous lymphadenitis

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.

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