Original articleGeneral thoracicEndobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculosis
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)
- et al.
Clinical role of bronchoscopy in adults with thoracic tuberculous lymphadenopathy
Chest
(1988) - et al.
Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology
Ann Thorac Surg
(2011) - et al.
Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration
Ann Thorac Surg
(2008) - et al.
Regional lymph node classification for lung cancer staging
Chest
(1997) - et al.
The current role of mediastinoscopy in the evaluation of thoracic disease
J Thorac Cardiovasc Surg
(1999) - et al.
Transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis
Chest
(2004) - et al.
Underutilization of transbronchial needle aspiration: experiences of current pulmonary fellows
Chest
(1997) - et al.
How I do it: optimal methodology for multidirectional analysis of endobronchial ultrasound-guided transbronchial needle aspiration samples
J Thorac Oncol
(2011) Chinese Tuberculosis Control Program Implementation Guidance
(2009)- et al.
Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review
Eur Respir J
(2009)
Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study
Thorax
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Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy: Experience from a tertiary care centre
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Sampling strategy for bacteriological diagnosis of intrathoracic tuberculosis
2021, Respiratory Medicine and ResearchCitation Excerpt :Nonetheless, contrary to BAL, TBNA procedure should be limited to patients with mediastinal or hilar lymphadenopathy visible in thoracic CT-scan and accessible to endo-bronchial ultrasound-guided (EBUS) TBNA. In this last situation, TBNA provides valuable support in the diagnosis of pulmonary TB [23–29], particularly in necrotic lymph nodes [29,38] and when ultrasound findings reveal clear boundaries and calcifications [28]. Above all, post-bronchoscopy sputum should be systematically collected after bronchoscopy each time BAL is performed, in view of its utility highlighted in our study and in others [39,40], to benefit to the full extent of the bronchoscopy.
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