Abstract
BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to perform mediastinal lymph node sampling. However, little information is available on polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy (IGL).MethodsA retrospective study using a prospectively collected database was performed from January 2010 to December 2014 to evaluate the efficacy of the TB-PCR test using EBUS-TBNA samples in patients with IGL. During the study period, 87 consecutive patients with isolated intrathoracic lymphadenopathy who received EBUS-TBNA were registered and 46 patients with IGL were included.ResultsOf the 46 patients with IGL, tuberculous lymphadenitis and sarcoidosis were diagnosed in 16 and 30 patients, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of TB-PCR for tuberculous lymphadenitis were 56, 100, 100, and 81 %, respectively. The overall diagnostic accuracy of TB-PCR for tuberculous lymphadenitis was 85 %. In addition, seven (17 %) patients had non-diagnostic results from a histological examination and all of them had non-diagnostic microbiological results of an acid-fast bacilli smear and culture. Four (57 %) of the seven patients with non-diagnostic results had positive TB-PCR results, and anti-tuberculosis treatment led to clinical and radiological improvement in all of the patients.ConclusionsTB-PCR using EBUS-TBNA samples is a useful laboratory test for diagnosing IGL. Moreover, this technique can prevent further invasive evaluation in patients whose histological and microbiological tests are non-diagnostic.
Highlights
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to perform mediastinal lymph node sampling
We conducted this study to examine the diagnostic performance of TBPCR using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy (IGL)
Study population From January 2010 to December 2014, a retrospective study with a prospectively collected database was performed to evaluate the efficacy of polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA samples in patients with IGL at Pusan National University Hospital
Summary
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to perform mediastinal lymph node sampling. Little information is available on polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy (IGL). Intrathoracic granulomatous lymphadenopathies (IGLs), such as tuberculous lymphadenitis and sarcoidosis, are frequently encountered by respiratory physicians, and their diagnosis is based on histological and microbiological tests [1,2,3]. Most IGLs comprise tuberculous lymphadenitis and sarcoidosis Differentiating between these IGLs using a histological examination alone is difficult. In addition to histological and microbiological tests, polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) is recognized as a useful test in the differential diagnosis of tuberculous lymphadenitis and sarcoidosis [10]. We conducted this study to examine the diagnostic performance of TBPCR using EBUS-TBNA samples in patients with IGL. We analyzed a prospectively collected database in South Korea, where the incidence of tuberculosis is intermediate (97/100,000 per year) [11]
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