Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.
OBJECTIVE
Patients with suspected tuberculosis without pulmonary lesions and with intrathoracic lymphadenopathy often pose a diagnostic challenge. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isoleted intrathoracic lymphadenopathy due to tuberculosis (TB).


METHODS
Cases with tuberculous lymphadenitis (TBLA) as the final diagnosis were analysed among patients in whom EBUS-TBNA had been performed. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, pathological findings, and microbiological results were recorded. All patients received 6-month antituberculous treatment, followed-up regularly and recovered both on clinical and radiological basis.


RESULTS
Forty-four patients were included. EBUS-TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4%) patients. In 2 patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7%) patients. One of the patients (2.2%) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50%) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation s improved the diagnostic yield from 72.7% to 95.4%.


CONCLUSIONS
EBUS-TBNA is a safe and effective first line investigation for evaluating isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of EBUS-TBNA.
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey. drnesrinkiral@yahoo.com.
Nesrin
N
Kiral
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey.
Benan
B
Caglayan
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey.
Banu
B
Salepci
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey.
Elif
E
Torun Parmaksiz
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey.
Ali
A
Fidan
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey.
Sevda Sener
SS
Comert
Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Pathology, Istanbul, Turkey.
Dilek
D
Yavuzer
Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Microbiology, Istanbul, Turkey.
Mualla
M
Partal
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D002648:Child; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy / Q000473:pathology*
D000995:Antitubercular Agents