Diagnosis of mediastinal tuberculosis by using EUS-guided needle sampling in a geographic region with an intermediate tuberculosis burden.
BACKGROUND
EUS-guided FNA (EUS-FNA) or trucut biopsy (TCB) is indispensible in the diagnosis of mediastinal malignancies. Less is known, however, about the usefulness of EUS-guided sampling for nonmalignant, mediastinal tuberculosis (TB), despite the increase in the incidence of TB.


OBJECTIVE
To assess the diagnostic yields of EUS-FNA/TCB in patients with mediastinal TB.


METHODS
Retrospective study.


METHODS
Tertiary-care referral hospital in a geographic region with an intermediate TB burden.


METHODS
This study involved 24 consecutive patients with mediastinal TB, who underwent EUS-FNA/TCB from July 2005 to September 2008.


METHODS
EUS-FNA/TCB.


METHODS
Technical success and diagnostic yields of EUS-FNA/TCB.


RESULTS
Mediastinal lesions (mean diameter, 28.6 mm; range 17.0-49.5 mm) were targeted by using 22-gauge-needle FNA in 10 patients and 19-gauge-needle TCB in 14 patients. Before EUS, only 10 of the 24 patients had a presumptive diagnosis of mediastinal TB, whereas 11 patients were suspected of having malignancies. Six patients showed mass-like lung parenchymal lesions mimicking lung cancer, and 7 patients had a history of malignancy. Pathologic examination showed granulomatous inflammation in 16 patients (66.7%), including 10 patients with caseating granulomas. Positive microbiologic results were obtained in 10 patients (41.7%): 3 by Ziehl-Neelsen staining, 5 by Mycobacterium tuberculosis culture, and 5 by TB polymerase chain reaction (PCR) assay. EUS-FNA/TCB confirmed mediastinal TB in 20 of the 24 patients and directed 11 patients clinically suspected of having malignancies to anti-TB treatment. The diagnostic yields of FNA and TCB were similar (90.0% vs 78.6%).


CONCLUSIONS
Retrospective design in a tertiary-care referral hospital.


CONCLUSIONS
EUS-FNA/TCB is sufficiently useful to confirm mediastinal TB and can exclude suspected malignancies in TB patients.
Song
Ho June
HJ
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Park
Young Soo
YS
Seo
Dong Wan
DW
Jang
Se Jin
SJ
Choi
Kee Don
KD
Lee
Sang Soo
SS
Lee
Gin Hyug
GH
Jung
Hwoon-Yong
HY
Kim
Jin-Ho
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000295:instrumentation*; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D019160:Endosonography / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
D004269:DNA, Bacterial