title: Initial experience with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from a tuberculosis endemic population.
abstract: BACKGROUND
  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely accepted minimally invasive procedure for the evaluation of mediastinal lymphadenopathy. Most of the published literature on EBUS-TBNA is focused on the diagnostic and staging aspects of lung cancer. Literature on the utility of this modality from developing countries and settings with a high prevalence of tuberculosis (TB) is limited. We herein describe our preliminary experience over 1 year on the utility of EBUS-TBNA from a tertiary care teaching center in North India.
  
  
  METHODS
  The primary objective was to evaluate the utility of convex probe EBUS-TBNA as a modality for diagnosis in patients with mediastinal lymphadenopathy presenting to our center. EBUS-TBNA was performed under local anesthesia and conscious sedation in the bronchoscopy laboratory. Rapid on-site evaluation was available for most of the procedures. Patients were discharged the same day from the hospital.
  
  
  RESULTS
  A total of 102 patients with mean age of 42.1±14.2 years underwent EBUS-TBNA for a clinical indication of enlarged mediastinal lymph nodes, between September 2012 and September 2013.There were 63 males (61.8%) and 39 females (38.2%). EBUS-TBNA was performed for staging lung cancer in 5 patients.A total of 216 lymph node stations were sampled in 102 patients. Rapid on-site evaluation was performed in 95 patients (93.1%). Adequate/representative samples could be obtained in 98 of 102 patients (96.1%). Overall, EBUS-TBNA was diagnostic in 76 patients (74.5%). EBUS-TBNA was diagnostic in 80.9%, 84.8%, and 75% of patients with sarcoidosis, TB, and lung cancer, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 81.7%, 100%, 100%, and 22.73%, respectively.
  
  
  CONCLUSIONS
  EBUS-TBNA is a safe and efficacious procedure for obtaining tissue diagnosis in patients with mediastinal lymph node enlargement. The yield of EBUS-TBNA in diagnosis of mediastinal lymph node enlargement due to TB is especially high.
authors.affiliation: Departments of *Pulmonary Medicine and Sleep Disorders †Pathology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
authors.forename: Karan
authors.initials: K
authors.lastname: Madan
authors.forename: Anant
authors.initials: A
authors.lastname: Mohan
authors.forename: Irfan I
authors.initials: II
authors.lastname: Ayub
authors.forename: Deepali
authors.initials: D
authors.lastname: Jain
authors.forename: Vijay
authors.initials: V
authors.lastname: Hadda
authors.forename: Gopi C
authors.initials: GC
authors.lastname: Khilnani
authors.forename: Randeep
authors.initials: R
authors.lastname: Guleria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000209:etiology / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D017565:Sarcoidosis, Pulmonary / Q000150:complications / Q000473:pathology*; D012680:Sensitivity and Specificity; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000473:pathology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000473:pathology*; D055815:Young Adult