title: Use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenopathy.
abstract: BACKGROUND
  This study assessed the clinical utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of suspected granulomatous mediastinal lymphadenopathy.
  
  
  METHODS
  Retrospective chart review of all patients who underwent EBUS-TBNA for suspected granulomatous mediastinal lymphadenopathy at Singapore General Hospital between December 2008 and December 2011 inclusive.
  
  
  RESULTS
  Over a period of 3 years, a total of 371 patients underwent EBUS-TBNA of whom 33 (9%) had the procedure performed for evaluation of suspected granulomatous mediastinal lymphadenopathy - 18 for suspected tuberculosis (TB) and non-tuberculous mycobacterial (NTM) lymphadenitis, and 15 for suspected sarcoidosis. EBUS-TBNA was diagnostic in 9 of the 13 patients with a final diagnosis of TB/NTM. EBUS-TBNA cultures were positive in 6 of them (46%), 1 showed acid-fast bacilli (AFB) although cultures were negative, and 2 had necrotising granulomatous inflammation from EBUS-TBNA biopsies and sputum cultures grew TB. EBUS-TBNA was diagnostic in 9 of the 14 patients with a final diagnosis of sarcoidosis through histology showing non-caseating granulomatous inflammation. The sensitivities of EBUS-TBNA for diagnosis of TB/NTM, sarcoidosis and overall granulomatous mediastinal lymphadenopathy were 69%, 64%, 64%; the negative predictive values were 56%, 17%, 33%; and accuracies were 78%, 67%, 70%, respectively.
  
  
  CONCLUSIONS
  EBUS-TBNA can be useful in the diagnosis of suspected granulomatous mediastinal lymphadenopathy with sensitivities and accuracies of >60%.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
authors.forename: Su Ying
authors.initials: SY
authors.lastname: Low
authors.forename: Mariko S
authors.initials: MS
authors.lastname: Koh
authors.forename: Thun How
authors.initials: TH
authors.lastname: Ong
authors.forename: Ghee Chee
authors.initials: GC
authors.lastname: Phua
authors.forename: Devanand
authors.initials: D
authors.lastname: Anantham
mesh_terms: D001999:Bronchoscopy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006099:Granuloma / Q000473:pathology*; D006801:Humans; D008206:Lymphatic Diseases / Q000473:pathology*; D008297:Male; D008477:Mediastinal Diseases / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies