Utility of EBUS-TBNA in diagnosing mediastinal tuberculous lymphadenitis in East London

  • Author Footnotes
    1 Current address: Division of Infection, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR.
    Olivia Lucey
    Correspondence
    Corresponding author at: Division of Infection, Barts Health NHS Trust, 80 Newark Street, Whitechapel, London E1 2ES, United Kingdom.
    Footnotes
    1 Current address: Division of Infection, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR.
    Affiliations
    Division of Infection, Barts Health NHS Trust, 80 Newark Street,Whitechapel, London E1 2ES, United Kingdom

    Department of Infectious Diseases, Imperial College London, South Kensington, London, United Kingdom
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  • Jessica Potter
    Affiliations
    Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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  • William Ricketts
    Affiliations
    Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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  • Lianne Castle
    Affiliations
    Department of Respiratory Medicine, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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  • Mark Melzer
    Affiliations
    Division of Infection, Barts Health NHS Trust, 80 Newark Street,Whitechapel, London E1 2ES, United Kingdom
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  • Author Footnotes
    1 Current address: Division of Infection, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR.
Published:October 24, 2021DOI:https://doi.org/10.1016/j.jinf.2021.10.015

      Highlights

      • EBUS-TBNA is a useful tool in the diagnosis of intrathoracic tuberculous lymphadenopathy and other pathologies.
      • In higher tuberculosis incidence areas, EBUS-TBNA samples from all cases of undiagnosed lymphadenopathy should undergo mycobacterial culture.
      • Clinical suspicion of tuberculosis does not always correlate with a confirmed diagnosis of tuberculosis.
      • Obtaining culture confirmation remains important in an era of significant drug-resistance.

      Summary

      Objectives

      To characterise and describe the diagnostic utility of Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in intrathoracic tuberculosis in a cohort of patients with mediastinal lymphadenopathy of unknown aetiology.

      Methods

      Consecutive patients with intrathoracic lymphadenopathy undergoing EBUS-TBNA between 2012 and 2016 were identified. Demographic data, biopsy cytopathology and mycobacteriology results, HIV and vitamin D status, susceptibility results and final diagnoses were recorded. Pre- and post-procedure probability scores were assigned to each case to reflect the probability of tuberculosis.

      Results

      315 cases were identified; 54 (17.1%) had tuberculosis and 261 (82.9%) had a non-tuberculosis diagnosis. amongst TB cases, the sensitivity of EBUS-TBNA was 59.3% (95% CI 45.06–72.14), specificity 100% (95% CI 98.19–100) and the negative predictive value (NPV) was 92.23% (95% CI 88.31–94.95). 19/54 (35%) TB cases were confirmed by EBUS mycobacterial culture and 13/54 (24.1%) by cytopathology.  33 (61.1%) of the TB cases, had a low to medium pre-test probability score assigned prior to EBUS-TBNA. Amongst EBUS culture-confirmed cases, we found a resistance rate of 10.5% to one or more first line TB drugs, with one case of multi-drug resistant TB.

      Conclusions

      We confirmed the utility of EBUS-TBNA in the diagnosis of intrathoracic tuberculosis in an undifferentiated cohort of patients with mediastinal lymphadenopathy of unknown aetiology and advocate sending samples for mycobacterial culture in all cases in high tuberculosis incidence areas.

      Keywords

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