title: Diagnosis of mediastinal tuberculosis by using EUS-guided needle sampling in a geographic region with an intermediate tuberculosis burden.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: 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
chemical_list: D004269:DNA, Bacterial