Chest
Volume 126, Issue 1, July 2004, Pages 259-267
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Bronchoscopy
Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculous Lymphadenitis

https://doi.org/10.1378/chest.126.1.259Get rights and content

Study objective:

To assess the role of transbronchial needle aspiration (TBNA) in diagnosing intrathoracic tuberculous lymphadenitis (TB-LA).

Methods:

In a tertiary referral center for thoracic medicine and surgery, using a CT scan as a guide, transbronchial aspirates were obtained with a 19-gauge flexible histology needle in consecutively enrolled patients with sputum smears negative for acid-fast bacilli, and with isolated mediastinal or hilar adenopathy suspicious for tuberculosis (TB).

Results:

Of 84 eligible patients who were all found to be HIV-negative, 63 (75%) cases of TB were diagnosed by TBNA (histology, 48 patients [76%]; cytology, 9 patients [14%]; and bacteriologic studies, 21 patients [33%; smear, 8 patients; culture, 17 patients]). TBNA was used to diagnose sarcoidosis in two patients, angioimmunoblastic lymphadenopathy in one patient, and Hodgkin lymphoma in one patient. In the 17 TBNA-negative patients, the results of transthoracic needle aspiration were positive in 12 patients (TB, nine patients; lung cancer, two patients; sarcoidosis, one patient), the results of mediastinoscopy were positive in three patients (TB, two patients; Hodgkin lymphoma, one patient), and the results of thoracotomy were positive in two patients (TB, two patients). Thus, 76 patients had TB, and all responded to anti-TB treatment. TB was corroborated by culture or histology of another specimen obtained from subsequently developed lesions in 40 patients (53%) during anti-TB treatment or posttreatment follow-up. TBNA was immediately diagnostic in 59 patients (78%), and exclusively in 52 patients (68%), among all bronchoscopic procedures and prebronchoscopic sputum studies. Sensitivity, specificity, positive and negative predictive values, and accuracy of TBNA for TB were 83%, 100%, 100%, 38%, and 85%, respectively. The only complication, self-limiting hemorrhage of < 30 mL volume, occurred in 65 patients (77%), with a volume of < 5 mL in 59 patients (70%).

Conclusion:

TBNA is efficient and safe in the bacteriologic and pathologic diagnosis of intrathoracic TB-LA in HIV-negative and sputum smear-negative patients.

Section snippets

Materials and Methods

The role of TBNA in diagnosing isolated intrathoracic TB-LA was studied from 1992 through 2000 at a tertiary referral center for thoracic medicine and surgery. Patient enrollment was carried out from 1992 through 1997, and follow-ups were conducted during and after treatment until 2001. Prebronchoscopically, consecutively enrolled patients were required to have mediastinal/hilar lymphadenopathy of ≥ 10 mm seen on a chest radiograph or thoracic CT scan, a history of TB contact, tuberculin test

Results

Of the 98 patients who were initially included in the study, 14 patients who refused to undergo or were intolerant of FB were excluded. Of the 84 eligible patients with isolated hilar or mediastinal lymphadenopathy who were all found to be HIV-negative (63 male patients and 21 female patients; mean [± SD] age, 24.2 ± 7.1; age range, 12 to 74 years; age < 15 years, 41 patients), TB was confirmed in 76. These 76 patients constituted 2.5% of 3,038 patients with thoracic TB diagnosed at our

Discussion

In the diagnosis and staging of bronchogenic carcinoma, larger-caliber histology needles (18-gauge or 19-gauge) for TBNA have been reported to increase the yield over that of 21-gauge or 22-gauge needles,2,23,26 and also have been shown to overcome the rare occurrence of false-positive cytologic results.4,23,27,28 Nevertheless, cytology needles have been providing adequate accuracy in the diagnosis and staging of bronchogenic carcinoma.1,2,3,4

The histology needle, which is also capable of

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    This study was presented in part at the American Thoracic Society Congress (Chicago, IL; April 24 to 29, 1998), and was published in abstract form.

    Retired.

    Currently at the Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey.

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