title: Clinical implications of granulomatous inflammation detected by endobronchial ultrasound transbronchial needle aspiration in patients with suspected cancer recurrence in the mediastinum.
abstract: BACKGROUND
  Granulomatous inflammation has been previously reported in association with cancer. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a new minimally invasive test for investigating mediastinal lymphadenopathy. The identification of granulomatous inflammation by EBUS-TBNA and the clinical implications of such detection in a series of patients with previously treated cancer and new mediastinal lymphadenopathy has not previously been performed.
  
  
  METHODS
  All 153 consecutive patients undergoing EBUS-TBNA in an academic cancer institution for suspected cancer in the mediastinum (mediastinal lymphadenopathy by CT imaging) were reviewed. Patients with non-caseating granuloma identified by EBUS-TBNA were included.
  
  
  RESULTS
  EBUS-TBNA identified non-caseating granuloma in 17/153 (11%) patients. A subset of 8/153 (5.2%) had sarcoid like lymphadenopathy mimicking cancer recurrence (5/5 PET positive). Another 8/153 (5.2%) patients with new mediastinal lymphadenopathy and no prior history of cancer had a clinical syndrome consistent with sarcoidosis. One other patient with a history of breast cancer was diagnosed with non-tuberculous mycobacteria infection. No patient required mediastinoscopy and there were no complications.
  
  
  CONCLUSIONS
  In an academic cancer institute, at least 5% of patients undergoing EBUS-TBNA have sarcoid-like lymphadenopathy mimicking cancer recurrence. Further studies to define the precise etiology, natural history and prognosis of this phenomenon are warranted.
authors.affiliation: Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. mpkennedy@uams.edu
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Kennedy
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Mhatre
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.forename: Georgie A
authors.initials: GA
authors.lastname: Eapen
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008479:Mediastinal Neoplasms / Q000175:diagnosis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed