Transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.
OBJECTIVE
To assess the role of transbronchial needle aspiration (TBNA) in diagnosing intrathoracic tuberculous lymphadenitis (TB-LA).


METHODS
In a tertiary referral center for thoracic medicine and surgery, using a CT scan as a guide, transbronchial aspirates were obtained with a 19-gauge flexible histology needle in consecutively enrolled patients with sputum smears negative for acid-fast bacilli, and with isolated mediastinal or hilar adenopathy suspicious for tuberculosis (TB).


RESULTS
Of 84 eligible patients who were all found to be HIV-negative, 63 (75%) cases of TB were diagnosed by TBNA (histology, 48 patients [76%]; cytology, 9 patients [14%]; and bacteriologic studies, 21 patients [33%; smear, 8 patients; culture, 17 patients]). TBNA was used to diagnose sarcoidosis in two patients, angioimmunoblastic lymphadenopathy in one patient, and Hodgkin lymphoma in one patient. In the 17 TBNA-negative patients, the results of transthoracic needle aspiration were positive in 12 patients (TB, nine patients; lung cancer, two patients; sarcoidosis, one patient), the results of mediastinoscopy were positive in three patients (TB, two patients; Hodgkin lymphoma, one patient), and the results of thoracotomy were positive in two patients (TB, two patients). Thus, 76 patients had TB, and all responded to anti-TB treatment. TB was corroborated by culture or histology of another specimen obtained from subsequently developed lesions in 40 patients (53%) during anti-TB treatment or posttreatment follow-up. TBNA was immediately diagnostic in 59 patients (78%), and exclusively in 52 patients (68%), among all bronchoscopic procedures and prebronchoscopic sputum studies. Sensitivity, specificity, positive and negative predictive values, and accuracy of TBNA for TB were 83%, 100%, 100%, 38%, and 85%, respectively. The only complication, self-limiting hemorrhage of < 30 mL volume, occurred in 65 patients (77%), with a volume of < 5 mL in 59 patients (70%).


CONCLUSIONS
TBNA is efficient and safe in the bacteriologic and pathologic diagnosis of intrathoracic TB-LA in HIV-negative and sputum smear-negative patients.
Bilaçeroğlu
Semra
S
Department of Thoracic Medicine, Izmir Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey. semrab@superonline.com
Günel
Ozden
O
Eriş
Nur
N
Cağirici
Ufuk
U
Mehta
Atul C
AC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
D000995:Antitubercular Agents