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Pulmonary Procedures |

EBUS-TBNA in Sarcoidosis and Lymphoma: Exploring the Importance of Culture on Lymph Nodes

Ping Shi Zhu, MD; Thomas Vandemoortele, MD
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Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montreal, QC, Canada


Chest. 2015;148(4_MeetingAbstracts):812A. doi:10.1378/chest.2259914
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Abstract

SESSION TITLE: Interventional Pulmonology Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an interesting tool in the investigation of sarcoidosis and lymphoma, but also as a means of excluding other pathologies. We aimed to describe the performance of EBUS-TBNA in the assessment of sarcoidosis and lymphoma, with attention given to alternative infectious diagnoses.

METHODS: We retrospectively reviewed the chart of 69 patients evaluated for sarcoidosis or lymphoma, who underwent EBUS-TBNA between January 2013 and December 2014 in our center. Efficacy of EBUS-TBNA was evaluated in terms of providing a specific diagnosis with pathological or microbiological analyses.

RESULTS: Mean age of patients was 55 years old (range 21-87), with 41(59.4%) males and 57(82.6%) Caucasians. EBUS-TBNA was performed for clinico-radiological suspicion of sarcoidosis in 51(73.9%), and for investigation of lymphoma in 18(26.1%) cases. Culture on lymph node was obtained in 47(68.1%). EBUS procedure yielded a diagnosis in 42(60.9%) out of 69: there were 25 sarcoidosis, 6 lymphomas, 5 cancers, 3 tuberculosis (TB), 1 Mycobacterium avium complex (MAC) and 2 other benign diseases. The 3 patients diagnosed with lymph node TB were from Bangladesh, Haiti and Togo. All 3 underwent EBUS-TBNA for suspicion of sarcoidosis (2 of them having radiologic features compatible with stage 1 and the other, with stage 2). Culture on lymph nodes showed TB in 3, while granulomas were detected in only 1 case. Bronchoalveolar lavage and bronchial aspirate culture were non diagnostic for all 3. MAC was found in an immunocompromised Caucasian with mediastino-hilar lymphadenopathy and suspected lymphoma. Diagnosis was obtained from EBUS-TBNA material which showed non-caseating granulomas and culture positive for MAC.

CONCLUSIONS: When assessing sarcoidosis or lymphoma, EBUS-TBNA provides both valuable pathological and microbiological material to explore alternative diagnoses such as mycobacterial infections. Culture on lymph nodes may reveal TB, with otherwise negative bronchoalveolar lavage and bronchial aspirate.

CLINICAL IMPLICATIONS: In suspected cases of sarcoidosis or lymphoma, culture on lymph nodes should be obtained with EBUS-TBNA, especially in patients from countries with high prevalence of TB.

DISCLOSURE: The following authors have nothing to disclose: Ping Shi Zhu, Thomas Vandemoortele

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