Pulmonary Procedures |

Current Diagnostic Techniques for Tuberculosis With Mediastinal Lymph Node Involvement FREE TO VIEW

Estefania Sanchez, MD; Felipe Andreo, PhD; Jose Sanz, PhD; Cristina Prat, MD; Joan Ruiz, PhD; Carmen Centeno Clemente, MD; Carlos Martinez Barenys, MD; Enrique Casas Viedema, PhD
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Hospital Germans Trias i Pujol, Badalona, Spain

Chest. 2014;145(3_MeetingAbstracts):488A. doi:10.1378/chest.1824863
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: In the diagnosis of tuberculosis (TB) with mediastinal nodal involvement it was essential to perform surgical techniques for sampling. Our purpose has been to analyse the use and diagnostic yield of the different current techniques

METHODS: Patients diagnosed with thoracic lymph node TB in two Spanish University Hospitals, for 7 years in one and 46 months in the second, were retrospectively analyzed. TB was confirmed by microbiology and/or pathological examination after endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) or trans-oesophageal endobronchial ultrasound-guided fine-needle aspiration (EUS-B-FNA), transtracheal needle aspiration using standard bronchoscopy or mediastinoscopy

RESULTS: 33 patients (mean age 47, 22 males) were diagnosed mediastinal lymph node and/or hiliar involvement TB. Conventional needle aspiration was performed in 1 case, EUS-B-FNA in 3, EBUS-TBNA in 22 and mediastinoscopy in 12, 7 of them without prior EBUS-TBNA. Mediastinoscopy was the only diagnostic technique in 27% (9/33). During EBUS-TBNA/EUS-B-FNA 62 stations were sampled, more punctured 7, 4R and 10L. Necrosis was observed in 17 cases (68%), granulomas in 14 (56%), the smear of the aspirate was positive in 24% and culture in 47.6%. Endosonography was decisive for the diagnosis in 63.6% (21/33) of cases. In two cases EBUS-TBNA was negative (8%), and it was necessary to perform mediastinoscopy.

CONCLUSIONS: Currently, puncture techniques guided by ultrasound bronchoscope are crucial for the diagnosis of tuberculosis with mediastinal lymph node involvement in most cases, and should be implemented in the routine diagnostic algorithm

CLINICAL IMPLICATIONS: Supported by a Grant from SEPAR 2010 and Fundación Catalunya Caixa 2012

DISCLOSURE: The following authors have nothing to disclose: Estefania Sanchez, Felipe Andreo, Jose Sanz, Cristina Prat, Joan Ruiz, Carmen Centeno Clemente, Carlos Martinez Barenys, Enrique Casas Viedema

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