Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study

Abstract

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an important tool for the diagnosis and staging of lung cancer but its role in the diagnosis of tuberculous intrathoracic lymphadenopathy has not been established. The aim of this study was to describe the diagnostic utility of EBUS-TBNA in patients with intrathoracic lymphadenopathy due to tuberculosis (TB). Methods 156 consecutive patients with isolated intrathoracic TB lymphadenitis were studied across four centres over a 2-year period. Only patients with a confirmed diagnosis or unequivocal clinical and radiological response to antituberculous treatment during follow-up for a minimum of 6 months were included. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, HIV status, pathological findings and microbiological results were recorded. Results EBUS-TBNA was diagnostic of TB in 146 patients (94%; 95% CI 88% to 97%). Pathological findings were consistent with TB in 134 patients (86%). Microbiological investigations yielded a positive culture of TB in 74 patients (47%) with a median time to positive culture of 16 days (range 3e84) and identified eight drug-resistant cases (5%). Ten patients (6%) did not have a specific diagnosis following EBUS; four underwent mediastinoscopy which confirmed the diagnosis of TB while six responded to empirical antituberculous therapy. There was one complication requiring an inpatient admission. Conclusions EBUS-TBNA is a safe and effective firstline investigation in patients with tuberculous intrathoracic lymphadenopathy.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

“…Additionally, numerous studies have reported the successful diagnosis of sarcoidosis by EBUS-TBNA (Garwood et al 2007;Tremblay and Stather, 2009). However, similar studies in patients with tuberculous lymphadenitis are limited (Navani et al, 2011). Likewise, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphoma also remains unclear.…”

Polymerase Chain Reaction Amplifying Mycobacterial DNA from Aspirates Obtained by Endoscopic Ultrasound Allows Accurate Diagnosis of Mycobacterial Disease in HIV-Positive Patients with Abdominal Lymphadenopathy

“…In our study mycobacterial culture was positive in only 67% of patients with the mean time to a positive culture of 25 days that would considerably delay initiation of effective therapy. A recent study in patients with isolated mediastinal lymphadenopathy suggests that culture yields may be lower in HIV positive patients (Navani et al 2011). In that study in a subgroup of 17 HIV positive patients only 36% had positive mycobacterial cultures.…”

“…In endemic areas, Mycobacterium tuberculosis (MTB) accounts for the majority of cases of lymphadenopathy but needs to be differentiated from infections by atypical mycobacteria, other bacterial species, fungi and parasites, conditions such as reactive lymphadenopathy and various malignancies (Giordani et al 2013;Radin 1995;Sarma et al 2010). Imaging studies alone fail to distinguish between different etiologies (Dos Santos et al 2008), with the consequence of inaccurate diagnoses and empirical treatment decisions (Mendelson 2007;Navani et al 2011). Due to the emergence of multidrug resistant tuberculosis MDR every effort should be made establishing the correct diagnosis and determine drug susceptibilities of the mycobacterium before commencing anti-tuberculosis therapy (Abbadi et al 2009;WHO 2010).…”

The role of bronchoscopy in the diagnosis of airway disease

“…Complication rates are low (0-3%) and include: hypoxia, respiratory failure, pneumomediastinum, pneumothorax, cardiac complications, and bleeding. Rarely sepsis and airway injury have been reported (25)(26)(27)(28). Lung nodules are often alternatively sampled via CT guided percutaneous biopsies, which can lead to a higher rate of pneumothorax or biopsy tract seeding.…”