Radial endobronchial ultrasound in diagnosing peripheral lung lesions in a high tuberculosis setting

Abstract

BackgroundCurrent data for the utility of radial endobronchial ultrasound (EBUS) in investigating peripheral lung lesions (PLLs) has been restricted to populations with low pulmonary tuberculosis (TB) incidence. The aim of this study was to assess the diagnostic utility of radial EBUS with guide sheath in the diagnosis of peripheral lung lesions in Singapore, a high TB incidence setting.MethodsA post-hoc database analysis was performed. 123 consecutive patients with computed tomographic evidence of PLLs who underwent radial EBUS guided bronchoscopy were included.ResultsThe final diagnosis was malignancy in 76 cases and benign in 44 cases. Radial EBUS guided bronchoscopy had a sensitivity of 65.8 % for malignancy, positive predictive value of 100 %, negative predictive value of 62.9 %, and a diagnostic accuracy of 82.5 %. 22 patients had a final diagnosis of pulmonary TB. The diagnostic sensitivity for pulmonary TB was 77.3 %, with a positive predictive value of 100 %, negative predictive value of 95.2 % and a diagnostic accuracy of 95.8 %. Overall, 58.8 % of pulmonary TB cases relied on histology to make an early diagnosis.ConclusionRadial EBUS guided bronchosopy is useful in investigating PLLs in a high TB incidence setting. Our data also suggests that radial EBUS is a more rapid diagnosis technique for tuberculous lesions.

Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis

“…The most frequent radiological demonstration is ground-glass, part-solid, and solid nodules on chest CT scans [7]. Primary lung cancer rarely presents as miliary nodules [8][9][10].…”

“…Their most frequent radiological demonstration is ground-glass, part-solid, and solid nodules on chest CT scans [7]. Primary lung cancer rarely presents as miliary nodules [8][9][10]. Here, we present the case of a 35-year-old male nonsmoking patient from a TB endemic area presenting with miliary mottling on chest X-ray and diagnosed as having adenocarcinoma of the lung.…”

Bronchoscopic techniques in the management of patients with tuberculosis

“…Bronchoscopic diagnosis of pulmonary TB traditionally relies on acid-fast bacilli smear microscopy, nucleic acid amplification techniques (NAATs), and Mycobacterium tuberculosis cultures (Theron et al, 2013;Jafari et al, 2011;Jafari et al, 2009;Jafari et al, 2006;Tueller et al, 2005;Mok et al, 2016;Tamura et al, 2010). Transbronchial needle aspiration (Reichenberger et al, 1999) and transbronchial biopsy (Theron et al, 2013;Chan et al, 2015;Jacomelli et al, 2012) may support the detection of cytological and histological TB findings (i.e., necrotizing granulomatous inflammation), but a positive culture is associated with the highest diagnostic accuracy (Theron et al, 2013;World Health Organization, 2015). Indeed, mycobacterial culture could provide further information on drug sensitivity (World Health Organization, 2015).…”

“…However, the diagnostic delay related to a time to positivity ranging from 2 to 6 weeks (Theron et al, 2013;Mok et al, 2016;Dheda et al, 2009) increases the probability of a poor prognosis (morbidity, mortality, and economic burden) and of Mycobacterium tuberculosis transmission (Theron et al, 2013;Jafari et al, 2009;Tueller et al, 2005;Dheda et al, 2009;Le Palud et al, 2014). Smear microscopy for the identification of acid-fast bacilli is rapid (onetwo days) and inexpensive (Mok et al, 2016), but its bacillary loadrelated sensitivity based on bronchoscopic specimens is low (Theron et al, 2013;Jafari et al, 2011;Jafari et al, 2009;Jafari et al, 2006;Tueller et al, 2005;Reichenberger et al, 1999;Chan et al, 2015;Jacomelli et al, 2012;Dheda et al, 2009;Le Palud et al, 2014;Barnard et al, 2015;Lee et al, 2013;Lin et al, 2010). NAAT, aimed to detect Mycobacterium tuberculosis nucleic acids, and histology have a good diagnostic yield, providing a response in a few days (Theron et al, 2013;Jafari et al, 2011;Jafari et al, 2009;Jafari et al, 2006;Tueller et al, 2005;Mok et al, 2016;Tamura et al, 2010;Chan et al, 2015;Jacomelli et al, 2012).…”

“…Smear microscopy for the identification of acid-fast bacilli is rapid (onetwo days) and inexpensive (Mok et al, 2016), but its bacillary loadrelated sensitivity based on bronchoscopic specimens is low (Theron et al, 2013;Jafari et al, 2011;Jafari et al, 2009;Jafari et al, 2006;Tueller et al, 2005;Reichenberger et al, 1999;Chan et al, 2015;Jacomelli et al, 2012;Dheda et al, 2009;Le Palud et al, 2014;Barnard et al, 2015;Lee et al, 2013;Lin et al, 2010). NAAT, aimed to detect Mycobacterium tuberculosis nucleic acids, and histology have a good diagnostic yield, providing a response in a few days (Theron et al, 2013;Jafari et al, 2011;Jafari et al, 2009;Jafari et al, 2006;Tueller et al, 2005;Mok et al, 2016;Tamura et al, 2010;Chan et al, 2015;Jacomelli et al, 2012). The combination of those techniques may significantly increase the sensitivity of bronchoscopy for the early diagnosis of pulmonary TB (Theron et al, 2013;Tueller et al, 2005;Mok et al, 2016;Tamura et al, 2010;Jacomelli et al, 2012).…”