ORIGINAL ARTICLES   

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

Copyright © 2014 EDIZIONI MINERVA MEDICA

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

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.