title: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in a Geographical Region With Endemic Histoplasmosis Infection.
abstract: OBJECTIVE
  In a geographical area with high prevalence of calcific granulomatous inflammation, calcified lymph nodes may affect the diagnostic adequacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to describe the diagnostic performance of EBUS-TBNA in a region endemic of histoplasmosis related granulomatous inflammation.
  
  
  METHODS
  A retrospective review was done for all patients referred for EBUS-TBNA over a 7-month period at 2 institutions. Computed tomographic (CT) chest studies were reviewed in a blinded manner by 2 radiologists. In parallel, CT images from 100 unselected sequential control patients were reviewed. Cytologic analysis of EBUS-TBNA aspirates was compared with a reference standard of definitive pathologic tissue diagnosis or a composite of ≥6-month clinical follow-up.
  
  
  RESULTS
  The prevalence of calcified lymph nodes in the 100 control patients was 56%. All 61 patients undergoing EBUS-TBNA were included. In total, 97 lymph nodes (mean size=13.8 mm) and 7 masses were biopsied. Definitive lymph node sampling was achieved in 51 of 61 patients (83%). The sensitivity, specificity, and positive and negative predictive values of EBUS-TBNA for malignancy (primary lung cancer staging, restaging, and reevaluation after cancer therapy, small cell lung cancer, lymphoma, and metastatic cancer) were 81%, 100%, 100%, and 84% respectively. On pre-EBUS CT chest scan, 60.6% had nodal calcification. The prevalence of cancer was not different in those with and without nodal calcification (49%). There was no difference in frequency of definitive lymph node sampling in those patients with or without nodal calcification.
  
  
  CONCLUSIONS
  In a geographical area with endemic histoplasmosis-related nodal calcification, there was no evidence of nodal calcification affecting the frequency of EBUS-TBNA definitive lymph node sampling.
authors.affiliation: *Division of Pulmonary and Critical Care Medicine Departments of †Radiology ‡Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR §Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: Yousef R
authors.initials: YR
authors.lastname: Shweihat
authors.forename: Rohan S
authors.initials: RS
authors.lastname: Samant
authors.forename: Manish
authors.initials: M
authors.lastname: Joshi
authors.forename: Hemendra
authors.initials: H
authors.lastname: Shah
authors.forename: Page C
authors.initials: PC
authors.lastname: Moore
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Kennedy