Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience.
BACKGROUND
Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis.


METHODS
A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard.


RESULTS
One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25%). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62% (24/39 cases). Specificity was 100%. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89% [95% confidence intervals (CI), 82-93%] and 91% (95% CI, 84-94%) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98% (95% CI, 93-99%) and 98% (95% CI, 95-99%) respectively. Sensitivity for NAAT was 38% (95% CI, 18-65%).


CONCLUSIONS
EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
James
J
Geake
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Gary
G
Hammerschlag
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Phan
P
Nguyen
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Peter
P
Wallbridge
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Grant A
GA
Jenkin
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Tony M
TM
Korman
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Barton
B
Jennings
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Douglas F
DF
Johnson
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Louis B
LB
Irving
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Michael
M
Farmer
1 Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Brisbane 4032, Australia ; 2 Department Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Australia ; 3 Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide 5000, Australia ; 4 Department of Infectious Diseases, Austin Hospital, Heidelberg 3084, Australia ; 5 Department of Infectious Diseases, 6 Monash Lung and Sleep, Monash Medical Centre, Clayton 3168, Australia ; 7 Department of Medicine, University of Melbourne, Parkville 3010, Australia.
Daniel P
DP
Steinfort
Endobronchial ultrasound (EBUS); PCR; bronchoscopy; culture; minimally invasive; mycobacteria; tuberculosis (TB)