Abstract
Background: The role of EBUS-TBNA in the diagnostic evaluation of suspected isolated tuberculous mediastinal lymphadenopathy (med TB) has been examined only in few studies1 . Our trust caters for a mixed ethnic population with TB rates of upto 80/100000. We analyzed the diagnostic yield of EBUS-TBNA in suspected med TB.
Method: Patients who were treated for isolated mediastinal tuberculosis following EBUS-TBNA in the period Jan 2012- June 2014 were included in our analysis. All had undergone contrast CT Thorax and who could expectorate had negative sputum culture prior to the procedure. EBUS TBNA was carried out using Olympus BF UC260 scope. The nodes were sampled using 22-gauge needle.
Result: 30 patients (mean age 44yrs, range 19-84 yrs, 18M, 12F) underwent EBUS TBNA for med TB. 37 nodes were sampled. {Station 7 (n=21), 10R (4), 10L (1), 4R (7), 4L(1), 2R (1) and unspecified hilar mass (2)}.
TBNA confirmed culture positive fully sensitive AFB in 43%(n=13), and granulomatous inflammation consistent with TB in 63%(n=19). Bronchial washings cultured positive in 3%(n=1). Samples obtained at EBUS were inconclusive in 5 (17%)patients. They were referred for surgical mediastinoscopy, which confirmed TB (positive histology in 5 and pos culture in 1). 1 patient was successfully treated empirically. Median time to treatment was 45 days (EBUS alone group) and 63 days (EBUS + mediastinoscopy group).
Conclusion: EBUS-TBNA helped to avoid surgical procedures in majority of patients. Our study supports early use of EBUS TBNA and simultaneous bronchial washings in patients with suspected isolated med TB.
Ref;
Rintoul RC, et al. Thorax 2015;70:175–180.
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