Journal Article

Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study

Connell, David W, Rintoul, Robert C, Lalvani, Ajit, Jepson, Annette, Kon, Onn Min, Nankivell, Matthew, Ng, Benjamin, Janes, Sam M, Molyneaux, Philip L, Brown, James M, Navani, Neal, Santis, George, Wickremasinghe, Melissa, Breen, Ronan A, Morris-Jones, Stephen

2011

Overview

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an important tool for the diagnosis and staging of lung cancer but its role in the diagnosis of tuberculous intrathoracic lymphadenopathy has not been established. The aim of this study was to describe the diagnostic utility of EBUS-TBNA in patients with intrathoracic lymphadenopathy due to tuberculosis (TB).Methods156 consecutive patients with isolated intrathoracic TB lymphadenitis were studied across four centres over a 2-year period. Only patients with a confirmed diagnosis or unequivocal clinical and radiological response to antituberculous treatment during follow-up for a minimum of 6 months were included. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, HIV status, pathological findings and microbiological results were recorded.ResultsEBUS-TBNA was diagnostic of TB in 146 patients (94%; 95% CI 88% to 97%). Pathological findings were consistent with TB in 134 patients (86%). Microbiological investigations yielded a positive culture of TB in 74 patients (47%) with a median time to positive culture of 16 days (range 3–84) and identified eight drug-resistant cases (5%). Ten patients (6%) did not have a specific diagnosis following EBUS; four underwent mediastinoscopy which confirmed the diagnosis of TB while six responded to empirical antituberculous therapy. There was one complication requiring an inpatient admission.ConclusionsEBUS-TBNA is a safe and effective first-line investigation in patients with tuberculous intrathoracic lymphadenopathy.

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / alveolar cell cancer / asbestos induced lung disease / asthma / asthma pharmacology / atypical mycobacterial infection / Bacterial diseases / bacterial infection / Biological and medical sciences / Biopsy, Fine-Needle - methods / Biopsy, Fine-Needle - statistics & numerical data / Bronchoscopy / Cancer therapies / Cardiology. Vascular system / Cellular biology / clinical epidemiology / COPD exacerbations / COPD pharmacology / Diagnosis, Differential / Disease / Drug resistance / Endoscopy / Endosonography - methods / Endosonography - statistics & numerical data / Female / Follow-Up Studies / Human bacterial diseases / Human immunodeficiency virus / Humans / infection control / Infectious diseases / innate immunity / Lung cancer / lung cancer chemotherapy / Lymph Nodes - diagnostic imaging / Lymph Nodes - microbiology / Lymph Nodes - pathology / Lymphatic system / lymphocyte biology / macrophage biology / Male / Medical sciences / mesothelioma / Middle Aged / Mycobacterium / Mycobacterium tuberculosis - isolation & purification / neutrophil biology / non-small cell lung cancer / opportunist lung infections / Pathology / Pneumology / pulmonary embolism / Reproducibility of Results / respiratory infection / Retrospective Studies / Sarcoidosis / small cell lung cancer / Thoracic Cavity / thoracic surgery / tobacco and the lung / Tuberculosis / Tuberculosis and atypical mycobacterial infections / Tuberculosis, Lymph Node - diagnostic imaging / Tuberculosis, Lymph Node - pathology / Ultrasonic imaging / University colleges / Young Adult