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Ann Thorac Surg. 2013 Dec;96(6):2021-7. doi: 10.1016/j.athoracsur.2013.07.005. Epub 2013 Sep 12.

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis.

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1
Department of Endoscopy Center and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China.

Abstract

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.

KEYWORDS:

11; AFB; CT; CT-TTNA; CT-guided transthoracic needle aspiration; EBUS-TBNA; EUS-FNA; TB; TBLA; WLB; acid-fast bacilli; computed tomography; endobronchial ultrasound-guided transbronchial needle aspiration; endoscopic ultrasound-guided fine needle aspiration; tuberculosis; tuberculous lymphadenitis; white light bronchoscopy

[Indexed for MEDLINE]

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