Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 6, December 2013, Pages 2021-2027
The Annals of Thoracic Surgery

Original article
General thoracic
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculosis

https://doi.org/10.1016/j.athoracsur.2013.07.005Get rights and content

Background

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has enabled mediastinal and hilar lymph node assessment with a high sensitivity, but its role in the diagnosis of intrathoracic tuberculosis (TB) has not been established.

Methods

We prospectively studied 59 patients suspected of having TB with thoracic lymph node lesions or intrapulmonary lesions accessible by EBUS-TBNA at a clinical center for thoracic medicine from January 2010 to December 2011. Bronchoscopic findings, EBUS-TBNA procedures, pathologic findings, and microbiologic results were recorded.

Results

Of 59 eligible patients, 41 patients had TB, 5 had lung cancer, 7 had inflammation, and 6 had sarcoidosis. Sensitivity was 85%, specificity was 100%, positive and negative predictive values were 100% and 75%, respectively, and accuracy was 90% by EBUS-TBNA for TB. Pathologic findings were consistent with TB in 80% of patients (33 of 41), and in 27% (11 of 41) the smear was positive. A total of 37 patients with TB had cultures, of whom 17 (46%) were positive. There were 80 mediastinal and hilar lymph nodes and 5 intrapulmonary lesions that were biopsied in the 41 patients with TB. Multivariate logistic regression revealed that short-axis diameter was an independent risk factor associated with positive pathology, smear, and culture (p < 0.05). Additionally, pathology showing necrosis was an independent risk factor associated with a positive culture.

Conclusions

Endobronchial ultrasound-guided transbronchial needle aspiration has a high diagnostic yield in the investigation of suspected intrathoracic TB by means of aspiration of intrathoracic lymph nodes and tracheobronchial wall-adjacent lung lesions.

Section snippets

Patients and Methods

The role of EBUS-TBNA in diagnosing TB was prospectively studied at a clinical center for thoracic medicine. Patient enrollment was performed from January 2010 to December 2011. Follow-up was conducted through December 2012. Endobronchial ultrasound-guided transbronchial needle aspiration was performed according to the following guidelines: (1) enlarged mediastinal/hilar lymph nodes (≥1 enlarged mediastinal or hilar lymphadenopathy >1 cm in short-axis) and/or tracheobronchial wall-adjacent

Results

Of 59 eligible patients, 27 were male, and the median age was 49 years (range, 17 to 70 years). TB was confirmed in 41 patients, lung cancer in 5, inflammation in 7, and sarcoidosis in 6. A TB diagnosis was established by EBUS-TBNA exclusively in 25 patients, by WLB exclusively in 2, by both EBUS-TBNA and WLB in 10, by thoracotomy in 3 (1 had confirmed-negative lymph nodes, suggesting that the EBUS-TBNA results were true-negatives, the other 2 being false-negatives), and by CT-TTNA in one (Fig 1

Comment

Pathology and bacteriology evidence of TB infection is considered the standard for diagnosis in those suspected of having intrathoracic TB. Surgical approaches, ie, mediastinoscopy and thoracoscopy, have the highest success rates but are more invasive, expensive, and need inpatient general anaesthesia. Furthermore, there is a 0.05% mortality with mediastinoscopy, and posterior-lower carinal and hilar nodes stations are generally inaccessible 12, 13. Less invasive measures are thus used:

References (23)

  • N. Navani et al.

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

    Thorax

    (2011)
  • Cited by (0)

    View full text