title: Sensitivity of convex probe endobronchial sonographically guided transbronchial needle aspiration in the diagnosis of granulomatous mediastinal lymphadenitis.
abstract: OBJECTIVE
  The purpose of this study was to investigate the sensitivity and diagnostic value of convex probe endobronchial sonographically guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenitis.
  
  
  METHODS
  Patients clinically and radiologically suspected to have granulomatous mediastinal disease and followed in our clinic between October 2008 and July 2010 were included. Convex probe EBUS with local anesthesia and under conscious sedation and EBUS-TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest radiography, computed tomography of the thorax, and routine biochemical analysis. Detection of noncaseating/caseating granulomas was accepted as sufficient for diagnosis of sarcoidosis/tuberculosis in the presence of clinical and radiologic findings. For patients whose EBUS-TBNA results were nondiagnostic, a definitive diagnosis was reached by invasive procedures. The sensitivity of EBUS-TBNA in the diagnosis of granulomatous lymphadenitis and diagnostic accuracy in granulomatous hilar/mediastinal lymphadenopathies was calculated.
  
  
  RESULTS
  Seventy-two patients were included in study (20 male and 52 female; mean age ± SD, 46.22 ± 13.94 years). In 72 cases, 121 lymph node aspirations were performed. The average lymph node short axis was 1.96 cm. With EBUS-TBNA among the 72 cases, 35 were diagnosed as sarcoidosis and 16 as tuberculous lymphadenitis. A definitive diagnosis could not be reached with EBUS-TBNA in 21 cases. As a result, 9 of these EBUS-TBNA-negative cases were diagnosed as reactive lymphadenitis, 9 as sarcoidosis, and 3 as tuberculosis by invasive procedures. The sensitivity values of EBUS-TBNA for diagnosis of sarcoidosis, tuberculosis, and granulomatous diseases were 79.5%, 84.2%, and 80.9%, respectively. The diagnostic accuracy of EBUS-TBNA for granulomatous diseases was 83.3%. No major complications occurred.
  
  
  CONCLUSIONS
  In the diagnosis of granulomatous lymphadenitis, EBUS-TBNA, with high sensitivity and a minimum complication rate, is an alternative to mediastinoscopy.
authors: Departments of Pulmonary Diseases, Research Hospital, Istanbul, Turkey. sevdasener2@yahoo.com
authors: Benan
authors: B
authors: Çağlayan
authors: Banu
authors: B
authors: Salepçi
authors: Ali
authors: A
authors: Fidan
authors: Nesrin
authors: N
authors: Kiral
authors: Sevda Sener
authors: SS
authors: Cömert
authors: Dilek
authors: D
authors: Yavuzer
authors: Recep
authors: R
authors: Demirhan
authors: Gülsen
authors: G
authors: Saraç
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000000981:diagnostic imaging*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008199:Lymphadenitis / Q000000981:diagnostic imaging*; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014159:Transducers; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult