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Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study
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  1. Neal Navani1,
  2. Philip L Molyneaux2,
  3. Ronan A Breen3,
  4. David W Connell2,
  5. Annette Jepson4,
  6. Matthew Nankivell5,
  7. James M Brown1,
  8. Stephen Morris-Jones6,
  9. Benjamin Ng7,
  10. Melissa Wickremasinghe2,
  11. Ajit Lalvani2,
  12. Robert C Rintoul7,
  13. George Santis3,
  14. Onn Min Kon2,
  15. Sam M Janes1
  1. 1Centre for Respiratory Research, University College London, London, UK
  2. 2Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
  3. 3Department of Thoracic Medicine, King's Health Partners, London, UK
  4. 4Department of Microbiology, Imperial College Healthcare NHS Trust, London, UK
  5. 5MRC Clinical Trials Unit, London, UK
  6. 6Department of Microbiology, University College Hospital, London, UK
  7. 7Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
  1. Correspondence to Dr Sam Janes, Centre for Respiratory Research, University College London, 5 University Street, London WC1E 6JJ, UK; s.janes{at}ucl.ac.uk

Abstract

Background Endobronchial 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).

Methods 156 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.

Results EBUS-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.

Conclusions EBUS-TBNA is a safe and effective first-line investigation in patients with tuberculous intrathoracic lymphadenopathy.

  • Bronchoscopy
  • lung cancer
  • mesothelioma
  • non-small cell lung cancer
  • small cell lung cancer
  • thoracic surgery
  • COPD exacerbations
  • atypical mycobacterial infection
  • opportunist lung infections
  • respiratory infection
  • tuberculosis
  • innate immunity
  • pulmonary embolism
  • bacterial infection
  • clinical epidemiology
  • infection control
  • lymphocyte biology
  • macrophage biology
  • neutrophil biology
  • sarcoidosis
  • alveolar cell cancer
  • asbestos induced lung disease
  • lung cancer chemotherapy
  • asthma
  • asthma pharmacology
  • COPD pharmacology
  • tobacco and the lung
  • lung cancer chemotherapy
  • non-small cell lung cancer
  • small cell lung cancer
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Footnotes

  • NN and PM are joint first authors.

  • OMK and SMJ are joint senior authors.

  • Funding NN is an MRC Clinical Research Training Fellow. SMJ is a Wellcome Trust Senior Fellow in Clinical Science. This study was partly undertaken at University College London Hospital/University College London who received a proportion of funding from the Department of Health's NIHR Biomedical Research Centre's funding scheme (NN, SMJ, SM-J). This study was also partly undertaken at St Mary's Hospital, Imperial College Healthcare NHS Trust which is supported by the NIHR Biomedical Research Centre funding scheme and the Centre for Respiratory Infection at Imperial College London, supported by the Wellcome Trust and partly undertaken at Papworth Hospital, Cambridge who are funded by the Department of Health's NIHR Biomedical Research Centre's funding scheme (RCR) and the Cambridge Experimental Cancer Medicines Centre.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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