Skip to main content

Advertisement

SpringerLink
Log in

The Diagnostic Utility of Endobronchial Ultrasound-Guided Trans-Bronchial Needle Aspiration (EBUS-TBNA) in Non-Malignant Mediastinal Lymphadenopathy: Experience from a High Tuberculosis Burden Tertiary Center

  • News/Views and Comments
  • Published:
National Academy Science Letters Aims and scope Submit manuscript

Abstract

Introduction

Mediastinal lymphadenopathy is a common radiological entity, with myriad etiologies. A significant proportion of the published literature on Endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) is focused on the diagnostic and staging aspects of lung cancer. However, the value of EBUS-TBNA in a high tuberculosis burden setting is not well established. We therefore sought to assess the diagnostic utility of EBUS-TBNA in suspected non-malignant mediastinal lymphadenopathy in a tertiary care referral center in North India.

Methods

In this prospective study, consecutive patients with suspected non-malignant mediastinal lymphadenopathy were included and underwent clinical assessment and contrast-enhanced computed tomography (CECT) to establish a baseline clinico-radiological-laboratory diagnosis (CRLD). EBUS-TBNA was performed, and aspirates were sent for cytology and microbiological tests for TB. In cases of non-diagnostic EBUS-TBNA, CRLD was used to guide therapy. Treatment was instituted, and follow-up was done at 6 months. The sensitivity, specificity, positive and negative predictive values of EBUS-TBNA were calculated on the basis of final diagnosis at 6 months. We also evaluated diagnostic utility of EBUS-TBNA as the percentage of patients wherein EBUS-TBNA diagnosis led to an alteration of management over CRLD-guided treatment.

Results

Ninety-six patients underwent the procedure, of which 55 (57%) had adequate and 47 (49%) had diagnostic EBUS-TBNA, respectively. Among those with adequate EBUS, TB was the most common diagnosis in 29 (53%) patients, followed by sarcoidosis in 14 (25%). One patient was diagnosed with non-TB mycobacterium infection, three patients had malignancy, and eight specimens showed reactive lymphadenitis. The sensitivity for diagnosis of TB and sarcoidosis was 85% and 88%, respectively, with a negative predictive value of 100% for both diagnoses. The diagnostic utility of an adequate EBUS-TBNA was 22% over CRLD, and 77% in cases where CRLD was indeterminate. The adequacy of EBUS-TBNA was significantly higher with lymph node size 2 cm compared to < 2 cm (63% vs. 37%, P < 0.001).

Conclusion

EBUS-TBNA is a valuable method in the evaluation of suspected non-malignant mediastinal lymphadenopathy in a high-TB-burden setting, providing specific diagnosis in about half of the patients. If adequate samples are obtained, utility of EBUS-TBNA is 22% overall and 77% in cases with indeterminate CRLD. The adequacy of procedure is significantly higher with lymph node size 2 cm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. WHO | Global report (2018) [Internet]. [cited 2019 Jan 10]. Available from: https://www.who.int/tb/publications/global_report/en/

  2. Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A et al (2017) Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 145(4):448–463

    PubMed  PubMed Central  Google Scholar 

  3. Nin CS, de Souza VVS, do Amaral RH, Schuhmacher Neto R, Alves GRT, Marchiori E, et al (2016) Thoracic lymphadenopathy in benign diseases: a state of the art review. Respir Med 112:10–17

    Article  Google Scholar 

  4. Bhalla AS, Das A, Naranje P, Goyal A, Guleria R, Khilnani GC (2017) Dilemma of diagnosing thoracic sarcoidosis in tuberculosis endemic regions: an imaging-based approach. Part 1. Indian J Radiol Imag 27(4):369–379

    Article  Google Scholar 

  5. Pham TD, Watanabe Y, Higuchi M, Suzuki H (2017) Texture analysis and synthesis of malignant and benign mediastinal lymph nodes in patients with lung cancer on computed tomography. Sci Rep 24(7):43209

    Article  ADS  Google Scholar 

  6. Sehgal IS, Dhooria S, Aggarwal AN, Behera D, Agarwal R (2016) Endosonography versus mediastinoscopy in mediastinal staging of lung cancer: systematic review and meta-analysis. Ann Thorac Surg 102(5):1747–1755

    Article  Google Scholar 

  7. Agarwal R, Srinivasan A, Aggarwal AN, Gupta D (2012) Efficacy and safety of convex probe EBUS-TBNA in sarcoidosis: a systematic review and meta-analysis. Respir Med 106(6):883–892

    Article  Google Scholar 

  8. Ettinger DS, Wood DE, Akerley W, Bazhenova LA, Borghaei H, Camidge DR et al (2016) NCCN guidelines insights: non-small cell lung cancer, version 4.2016. J Natl Compr Cancer Netw JNCCN. 14(3):255–264

    Article  Google Scholar 

  9. Sehgal IS, Dhooria S, Aggarwal AN, Agarwal R (2017) Training and proficiency in endobronchial ultrasound-guided transbronchial needle aspiration: a systematic review. Respirol Carlton Vic 22(8):1547–1557

    Article  Google Scholar 

  10. Thangakunam B, Isaac BTJ, Christopher DJ (2017) Endobronchial ultrasound experience in a high tuberculosis prevalence setting. Indian J Tuberc 64(3):196–200

    Article  Google Scholar 

  11. Eom JS, Mok JH, Lee MK, Lee K, Kim MJ, Jang SM et al (2015) Efficacy of TB-PCR using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy. BMC Pulm Med 28(15):166

    Article  Google Scholar 

  12. Eickhoff L, Golpon H, Zardo P, Suhling H, Welte T, Jonigk D et al (2018) Endobronchial ultrasound in suspected non-malignant mediastinal lymphadenopathy. Pneumol Stuttg Ger 72(8):559–567

    CAS  Google Scholar 

  13. Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P, et al. (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. 4(5):568–77

  14. Gahlot T, Parakh U, Verma K, Bhalotra B, Jain N (2017) Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy. Lung India Off Organ Indian Chest Soc 34(3):241–246

    Google Scholar 

  15. Anderson ST, Kaforou M, Brent AJ, Wright VJ, Banwell CM, Chagaluka G et al (2014) Diagnosis of childhood tuberculosis and host RNA expression in Africa. N Engl J Med 370(18):1712–1723

    Article  CAS  Google Scholar 

  16. Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM et al (2015) Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis 7(3):439–448

    PubMed  PubMed Central  Google Scholar 

  17. Figueiredo VR, Cardoso PFG, Jacomelli M, Demarzo SE, Palomino ALM, Rodrigues AJ et al (2015) Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil. J Bras Pneumol Publicacao Of Soc Bras Pneumol E Tisilogia 41(1):23–30

    Google Scholar 

  18. Medford ARL, Bennett JA, Free CM, Agrawal S (2010) Endobronchial ultrasound guided transbronchial needle aspiration. Postgrad Med J 86(1012):106–115

    Article  CAS  Google Scholar 

  19. Herth FJF, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M (2006) Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. Eur Respir J 28(5):910–914

    Article  CAS  Google Scholar 

  20. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y et al (2007) The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg 134(6):1485–1490

    Article  Google Scholar 

  21. Erer OF, Erol S, Anar C, Biçmen C, Aydoğdu Z, Aktoğu S (2017) The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal tuberculous lymphadenitis. Turk J Med Sci 47(6):1874–1879

    Article  Google Scholar 

  22. Chalela R, Sánchez-Font A, Domínguez-Álvarez M, Badenes-Bonet D, Pijuan L, Curull V (2016) Role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal tuberculosis. Med Clin (Barc). Apr 26

  23. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T et al (2004) Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest 126(1):122–128

    Article  Google Scholar 

  24. Madan K, Mohan A, Ayub II, Jain D, Hadda V, Khilnani GC et al (2014) Initial experience with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from a tuberculosis endemic population. J Bronchol Interv Pulmonol 21(3):208–214

    Article  Google Scholar 

  25. Tian Q, Chen L, Wang H, Zhu B, Tian L, Yang Z et al (2010) Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed mediastinal lymphadenopathy. Chin Med J (Engl) 123(16):2211–2214

    Google Scholar 

  26. Steinfort DP, Hew MJ, Irving LB (2011) Bronchoscopic evaluation of the mediastinum using endobronchial ultrasound: a description of the first 216 cases carried out at an Australian tertiary hospital. Intern Med J 41(12):815–824

    Article  CAS  Google Scholar 

  27. Gindesgaard CB, Schousboe LP, Christensen RK (2013) Endobronchial ultrasound-guided transbronchial needle aspiration in an unselected cohort. J Bronchol Interv Pulmonol 20(2):140–146

    Article  Google Scholar 

  28. Szlubowski A, Kuzdzał J, Pankowski J, Obrochta A, Soja J, Hauer J et al (2008) Ultrasound guided transbronchial needle aspiration as a diagnostic tool for lung cancer and sarcoidosis. Pneumonol Alergol Pol 76(4):229–236

    PubMed  Google Scholar 

  29. Lange TJ, Kunzendorf F, Pfeifer M, Arzt M, Schulz C (2012) Endobronchial ultrasound-guided transbronchial needle aspiration in routine care - plenty of benign results and follow-up tests. Int J Clin Pract 66(5):438–445

    Article  CAS  Google Scholar 

  30. Srinivasan A, Agarwal R, Gupta N, Aggarwal AN, Gupta D (2013) Initial experience with real time endobronchial ultrasound guided transbronchial needle aspiration from a tertiary care hospital in north India. Indian J Med Res 137(4):803–807

    PubMed  PubMed Central  Google Scholar 

  31. Gupta D, Agarwal R, Aggarwal AN, Jindal SK (2012) Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders. Curr Opin Pulm Med 18(5):506–516

    Article  Google Scholar 

  32. Litinsky I, Elkayam O, Flusser G, Segal R, Yaron M, Caspi D (2002) Sarcoidosis: TB or not TB? Ann Rheum Dis 61(5):385–386

    Article  CAS  Google Scholar 

  33. Mian A, Ray A (2018) Thoracic sarcoidosis versus tuberculosis: Need for a multi-disciplinary approach. Indian J Radiol Imag 28(2):267–268

    Article  Google Scholar 

  34. Manucha V, Kaur G, Verma K (2013) Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes: experience from region with high prevalence of tuberculosis. Diagn Cytopathol 41(12):1019–1022

    Article  Google Scholar 

  35. Dhooria S, Sehgal IS, Gupta N, Aggarwal AN, Behera D, Agarwal R (2017) Diagnostic yield and complications of EBUS-TBNA performed under bronchoscopist-directed conscious sedation: single center experience of 1004 subjects. J Bronchol Interv Pulmonol 24(1):7–14

    Article  Google Scholar 

  36. Gupta N, Muthu V, Agarwal R, Dhooria S (2019) Role of EBUS-TBNA in the diagnosis of tuberculosis and sarcoidosis. J Cytol 36(2):128–130

    Article  Google Scholar 

  37. Dhooria S, Agarwal R, Aggarwal AN, Bal A, Gupta N, Gupta D (2014) Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: a study of 165 patients. J Thorac Cardiovasc Surg 148(2):662–667

    Article  Google Scholar 

  38. Hu Y, Puri V, Crabtree TD, Kreisel D, Krupnick AS, Patterson AG et al (2013) Attaining proficiency with endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Cardiovasc Surg 146(6):1387-1392.e1

    Article  Google Scholar 

  39. Gurioli C, Ravaglia C, Romagnoli M, Casoni G, Tomassetti S, Nanni O et al (2012) EBUS-TBNA in mediastinal/hilar lymphadenopathies and/or masses: an Italian case series. Clin Respir J 6(1):3–8

    Article  Google Scholar 

  40. Kemp SV, El Batrawy SH, Harrison RN, Skwarski K, Munavvar M, Rosell A et al (2010) Learning curves for endobronchial ultrasound using cusum analysis. Thorax 65(6):534–538

    Article  CAS  Google Scholar 

  41. Stather DR, Chee A, MacEachern P, Dumoulin E, Hergott CA, Gelberg J et al (2015) Endobronchial ultrasound learning curve in interventional pulmonary fellows. Respirol Carlton Vic 20(2):333–339

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India

    Agrima Mian, Animesh Ray, Achintya Dinesh Singh, Jigyasa Chaubey & Sanjeev Sinha

  2. Departments of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Sandeep Mathur & Deepali Jain

Authors
  1. Agrima Mian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Animesh Ray
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Achintya Dinesh Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandeep Mathur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deepali Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jigyasa Chaubey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sanjeev Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanjeev Sinha.

Ethics declarations

Conflict of interest

None.

Data availability

The data used to support the findings of the study are available from the corresponding author upon request.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Significance Statement: Mediastinal lymphadenopathy is a common radiological entity, with myriad etiologies. A significant proportion of the published literature on Endobronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) is focused on the diagn`ostic and staging aspects of lung cancer.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mian, A., Ray, A., Singh, A.D. et al. The Diagnostic Utility of Endobronchial Ultrasound-Guided Trans-Bronchial Needle Aspiration (EBUS-TBNA) in Non-Malignant Mediastinal Lymphadenopathy: Experience from a High Tuberculosis Burden Tertiary Center. Natl. Acad. Sci. Lett. 44, 575–584 (2021). https://doi.org/10.1007/s40009-021-01079-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40009-021-01079-2

Keywords

Search

Navigation