Serhat EROL, Zekiye AYDOĞDU, Serir AKTOĞU, Can BİÇMEN, Ceyda MAHLEÇ ANAR, Onur Fevzi ERER

The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal tuberculous lymphadenitis

Background/aim: Mediastinal lymph nodes are the second most commonly affected lymph nodes in tuberculous lymphadenitis. It is often difficult to diagnose tuberculosis in patients with lymphadenopathy without parenchymal lesions. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isolated mediastinal tuberculous lymphadenitis (MTLA). Materials and methods: This study included 527 patients who had undergone EBUS-TBNA between December 2012 and December 2014. Patients with the final diagnosis of MTLA were evaluated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EBUS-TBNA were calculated. Results: The prevalence of MTLA in all patients who had undergone EBUS-TBNA for mediastinal lymphadenopathy of unknown etiology was 5.2% (28/527). EBUS-TBNA was diagnostic in 21/28 (75%) patients, and the remaining 7 patients required additional procedures for confirmation of diagnosis. Sensitivity, specificity, PPV, NPV, and accuracy of combined cytopathological and microbiological examinations of EBUS-TBNA in the diagnosis of MTLA were 87.5%, 98.5%, 91.4%, 98%, and 94.4%, respectively. There were no major complications. Conclusion: EBUS-TBNA is a safe and effective procedure for the diagnosis of MTLA. When microbiological and cytopathological examinations of samples are combined, EBUS-TBNA demonstrates good diagnostic accuracy and NPV for the diagnosis of MTLA.

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1. Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004; 120: 316-353.
2. Salvador F, Los-Arcos I, Sanchez-Montalva A, Tortola T, Curran A, Villar A, Saborit N, Castellví J, Molina I. Epidemiology and diagnosis of tuberculous lymphadenitis in a tuberculosis lowburden country. Medicine 2015; 94: 1-6.
3. TB CARE I. International Standards for Tuberculosis Care. 3rd ed. The Hague, the Netherlands: TB CARE I; 2014.
4. Fontanilla JM, Barnes A, Fordham von Reyn C. Current diagnosis and management of peripheral tuberculous lymphadenitis. Clin Infect Dis 2011; 53: 555-562.
5. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberculosis and Respiratory Diseases 2015; 78: 47-55.
6. Jacob B, Parsa R, Frizzell R, Mearns A, Smith P. Mediastinal tuberculosis in Bradford, United Kingdom: the role of mediastinoscopy. Int J Tuberc Lung D 2011; 15: 240-245.
7. Jalil BA, Yasufuku K, Khan AM. Uses, limitations, and complications of endobronchial ultrasound. Baylor University Medical Center Proceedings 2015; 28: 325-330.
8. Tortoli E, Cichero P, Piersimoni C, Simonetti MT, Gesu G, Nista D. Use of BACTEC MGIT 960 for recovery of mycobacteria from clinical specimens: multicenter study. J Clin Microbiol 1999; 37: 3578-3582.
9. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC. Mycobacteria. In: Color Atlas and Textbook of Diagnostic Microbiology. 4th ed. Philadelphia, PA, USA: J. B. Lippincott Company; 1992. pp. 703-755.
10. Navani N, Molyneaux PL, Breen RA, Connell DW, Jepson A, Nankivell M, Brown JM, Morris-Jones S, Ng B, Wickremasinghe M et al. Utility of endobronchial ultrasoundguided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study. Thorax. 2011; 66: 889-893.
11. Hassan T, McLaughlin AM, OConnell F, Gibbons N, Nicholson S, Keane J. BUS-TBNA performs well in the diagnosis of isolated thoracic tuberculous lymphadenopathy. Am J Resp Crit Care 2011; 183: 136-137.
12. Sun J, Teng J, Yang H, Li Z, Zhang J, Zhao H, Garfield DH, Han B. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis. Ann Thorac Surg 2013; 96: 2021-2027.
13. Kuo CH, Lin SH, Lee KY, Chung FT, Feng PH, Hsiung TC, Lo YL, Liu CY, Kuo HP. Algorithmic approach by endobronchial ultrasound-guided transbronchial needle aspiration for isolated intrathoracic lymphadenopathy: a study in a tuberculosis endemic country. J Formos Med Assoc 2014; 113: 527-534.
14. Low SY, Koh MS, Ong TH, Phua GC, Anantham D. Use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenopathy. Ann Acad Med Singap 2014; 43: 250-254.
15. Madan K, Mohan A, Ayub II, Jain D, Hadda V, Khilnani GC, Guleria R. Initial experience with endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) from a tuberculosis endemic population. Journal of Bronchology and Interventional Pulmonology 2014; 21: 208-214.
16. Senturk A, Arguder E, Hezer H, Babaoglu E, Kilic H, Karalezli A, Hasanoglu HC. Rapid diagnosis of mediastinal tuberculosis with polymerase chain reaction evaluation of aspirated material taken by endobronchial ultrasound guided transbronchial needle aspiration. J Invest Med 2014; 62: 885-889.
17. Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM, Jennings B, Johnson DF, Irving LB, Farmer M et al. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. Journal of Thoracic Disease 2015; 7: 439-448.
18. Asimacopoulos EP, Berry M, Garfield B, Roesner M, Jepson A, McCarthy J, Kon OM. The diagnostic efficacy of fineneedle aspiration using cytology and culture in tuberculous lymphadenitis. Int J Tuberc Lung D 2010; 14: 93-98.
19. Biadglegne F, Tesfaye W, Sack U, Rodloff AC. Tuberculous lymphadenitis in Northern Ethiopia: in a public health and microbiological perspectives. PLoS One 2013; 8: e81918.
20. Puri R, Vilmann P, Sud R, Kumar M, Taneja S, Verma K, Kaushik N. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy. Endoscopy 2010; 42: 462-467.
21. Berzosa M, Tsukayama DT, Davies SF, Debol SM, Cen YY, Li R, Mallery S. Endoscopic ultrasound-guided fine needle aspiration for the diagnosis of extra-pulmonary tuberculosis. Int J Tuberc Lung D 2010; 14: 578-584.
22. Theron G, Peter J, Calligaro G, Meldau R, Hanrahan C, Khalfey H, Matinyenya B, Muchinga T, Smith L, Pandie S et al. Determinants of PCR performance (Xpert MTB/RIF), including bacterial load and inhibition, for TB diagnosis using specimens from different body compartments. Scientific Reports 2014; 4: 5658.
23. Daley P, Thomas S, Pai M. Nucleic acid amplification tests for the diagnosis of tuberculous lymphadenitis: a systematic review. Int J Tuberc Lung D 2007; 11: 1166-1176.
24. World Health Organization. WHO Policy Update: Xpert MTB/ RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children. Geneva, Switzerland: World Health Organization; 2013.
25. Mehta PK, Raj A, Singh N, Khuller GK. Diagnosis of extrapulmonary tuberculosis by PCR. FEMS Immunol Med Mic 2012; 66: 20-36.
26. Handa U, Mundi I, Mohan S. Nodal tuberculosis revisited: a review. Journal of Infection in Developing Countries 2012; 6: 6-12.
27. Curvo-Semedo L, Teixeira L, Caseiro-Alves F. Tuberculosis of the chest. Eur J Radiol 2005; 55: 158-172.
28. Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. RadioGraphics 2007; 27: 1255-1273.