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Panminerva Medica 2013 December;55(4):363-70

lingua: Inglese

Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques enhanced the diagnosis yields of pulmonary tuberculosis patients with lymphadenopathy

Ren S. 1, 2, Zhang Z. 3, Jiang H. 2, 4, Wu C. 5, Liu J. 6, Liang L. 7, Li B. 1, Liu L. 1, Wang H. 2, 8, Schmid-Bindert G. 9

1 Department of Medical Oncology Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
2 Department of Videobronchoscopes Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
3 Department of Respiratory Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
4 Department of Emergency Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
5 Department of Pathology, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
6 Department of Anesthesiology Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China
7 Department of Tuberculosis Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
8 Department of Surgery, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China;
9 Interdisciplinary Thoracic Oncology Department of Surgery University Medical Center Mannheim Medical Faculty Mannheim of Heidelberg University Mannheim, Germany


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Aim: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was reported to be useful for diagnosis of tuberculosis (TB) lymphadenitis, although its indication remains unclear for suspicious pulmonary TB patients. To clarify the role of EBUS-TBNA for the diagnosis of immunocompetent TB patients with intrathoracic lymphadenopathy, we compared two diagnostic modalities: traditional bronchoscopy alone and EBUS-TBNA combined with bronchoscopy.
Methods: We retrospectively studied 175 patients of suspicious pulmonary TB with intrathoracic lymphadenopathy in a single institute (Tongji University, Shanghai, China) from January 2010 to May 2011.
Results: Ninety-seven patients underwent traditional bronchoscopy alone while 78 received the combined diagnostic techniques. Sensitivity and specificity were 18.1% and 100%, respectively, in the bronchoscopy group alone, and 80% and 92.3%, respectively, in the EBUS-TBNA combination group (absolute increase in sensitivity, 61.9%; P<0.001; 95% CI, 48.7-75.1%). In the combination group, EBUS-TBNA alone was diagnostic of TB in 42 patients (64.6%, 95% CI, 53-76.2%). Bleeding without hemodynamic instability developed in two patients during the procedure of EBUS-TBNA and no hospitalization prolongation happened in the both arms.
Conclusion: Combination of EBUS-TBNA with standard bronchoscopic technique is safe and significantly increases the diagnostic yield in patients of suspicious pulmonary TB with lymphadenopathy.

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