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. 2015 Dec 28:15:166.
doi: 10.1186/s12890-015-0162-4.

Efficacy of TB-PCR using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy

Jung Seop Eom  1   2 , Jeong Ha Mok  3   4 , Min Ki Lee  5   6 , Kwangha Lee  7 , Min Ji Kim  8 , Sun Mi Jang  9 , Hae Jung Na  10 , Seung Eon Song  11 , Geewon Lee  12 , Eun-Jung Jo  13 , Mi-Hyun Kim  14 , Ki Uk Kim  15 , Hye-Kyung Park  16
Affiliations

Efficacy of TB-PCR using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy

Jung Seop Eom et al. BMC Pulm Med. .

Abstract

Background: Endobronchial 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).

Methods: A 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.

Results: Of 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.

Conclusions: TB-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.

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Figures

Fig. 1
Fig. 1
Study flow diagram. *Of the five patients with reactive hyperplasia, two were confirmed by subsequent mediastinoscopy, and a CT scan of the remaining three patients showed decreased or unchanged lymph node sizes. †All five patients with anthracotic lymph nodes were followed up for more than 6 months, and the lymph node size was decreased or unchanged on subsequent CT. ‡In six patients who were lost to follow-up, the results of EBUS-TBNA were insufficient specimens in three patients and reactive hyperplasia in the other patients. §Histological specimens were classified into five grades: I) epithelioid granulomatous reaction with caseation, II) epithelioid granulomatous reaction without caseation, III) nongranulomatous reaction with necrosis, IV) nonspecific, and V) inadequate sample. EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration; IGL, intrathoracic granulomatous lymphadenopathy; TB-PCR, polymerase chain reaction for Mycobacterium tuberculosis
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