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Correspondence |

Single Bronchoscope Combined Endoscopic-Endobronchial Ultrasound-Guided Fine-Needle Aspiration for Tuberculous Mediastinal Nodes FREE TO VIEW

Andrew R. L. Medford, DM; Sanjay Agrawal, MBBS, FCCP
Author and Funding Information

From the Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust.Dr Medford is currently at North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, England.

Correspondence to: Andrew R. L. Medford, DM, North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, Leicester, England; e-mail: andrewmedford@hotmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1274. doi:10.1378/chest.10-0617
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To the Editor:

We fully support the use of a single linear endobronchial ultrasound (EBUS) bronchoscope for both endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of mediastinal lymph nodes, as reported in the recent CHEST article by Herth et al.1 Having initially established and reported our own results with EBUS-TBNA for both malignant and benign disease,2,3 we have more recently moved to performing EUS-FNA and EBUS-TBNA with a single linear EBUS bronchoscope for benign and malignant nodes. We would like to add the particular utility of EUS-FNA in nonmalignant disease as well as the more common utility in malignant disease. In our first five combined EBUS-TBNA/EUS-FNA procedures via a single EBUS bronchoscope, three patients with suspected TB (enlarged subcarinal and hilar nodes but no parenchymal lung disease) had TB diagnosed (caseous granulomatous histologic results with positive TB culture) from the EUS-FNA only (with only one positive histologic examination and culture from EBUS-TBNA, and all negative on BAL). In addition, the antibiotic sensitivities from mediastinal lymph node culture are helpful to ongoing management of the TB. (The remaining two cases were for suspected malignancy, metastatic renal cell carcinoma and non-small cell lung cancer, which were confirmed at EBUS-TBNA and EUS-FNA of subcarinal nodes).

We have also found EUS-FNA more tolerable to some patients than EBUS-TBNA, particularly those with pronounced cough despite adequate conscious sedation and those with poor lung function and significant comorbid lung disease. This can be particularly helpful if Station 7 is a target or there is a paraesophageal lymph node. Obviously, the cost savings of another EUS scope are also welcome in resource-rationed health-care systems. In summary, combined EUS-FNA/EBUS-TBNA is likely to become more commonplace for all the above reasons but should not be overlooked in the diagnosis of benign disease accessible by this technique.

Herth FJF, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided, fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;1384:790-794. [CrossRef] [PubMed]
 
Medford AR, Agrawal S, Free CM, Bennett JA. A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM. 2009;10212:859-864. [CrossRef] [PubMed]
 
Medford AR, Agrawal S, Bennett JA. Sarcoidosis. Technique to enable diagnosis. BMJ. 2009;339:766-767. [CrossRef]
 

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References

Herth FJF, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided, fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;1384:790-794. [CrossRef] [PubMed]
 
Medford AR, Agrawal S, Free CM, Bennett JA. A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM. 2009;10212:859-864. [CrossRef] [PubMed]
 
Medford AR, Agrawal S, Bennett JA. Sarcoidosis. Technique to enable diagnosis. BMJ. 2009;339:766-767. [CrossRef]
 
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