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Pulmonary Procedures |

Diagnostic Value of Cytology, Gene Xpert, and Mycobacterial Cultures in EBUS-TBNA Aspirate

Pattabhi Raman Vallandramam, MD; Arjun Srinivasan, DM; Mahadevan Sivaramakrishnan, MD; Pavan Yadav, MD
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Kovai Medical Center and Hospital, Coimbatore, India


Chest. 2015;148(4_MeetingAbstracts):804A. doi:10.1378/chest.2280153
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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: In an endemic country like India mediastinal lymphadenopathy secondary to tuberculosis is common. EBUS-TBNA is increasingly being used to evaluate such cases, this study was undertaken to assess the diagnostic yield of various tests from the nodal aspirate.

METHODS: Retrospective analysis of all patients undergoing EBUS-TBNA with a clinical possibility of tuberculosis at a tertiary care referral center between September 2013 and October 2014. All patient had atleast four passes from each node of which one pass from each lymphnode sampled in 2ml of saline for culture and Gene xpert as per hospital protocol.

RESULTS: A total of 31 patients underwent EBUS-TBNA during this period with a clinical probability of tuberculosis, of these; aspirate yielded alternate diagnosis in 9 patients. A total of 22 patients (16 males and 6 females) were diagnosed with tuberculosis with a mean age of 34.5 years. Aspirate showed necrotizing granulomatous inflammation on cytology in 20 patients (90.9%), smear for acid fast bacilli was positive in 14 patients (63.63%), Gene xpert was positive in 15 patients (68.1%) and mycobacterial cultures positive in 9 patients (41%). Of the 13 patients in whom Mycobacterial culture was negative, seven were on empiric anti-tubercular therapy (Gene xpert positive in 5 patients and smear positive with granulomas in cytology in the other 2). Of the remaining six patients 4 had Gene Xpert positivity and 2 had only necrotizing granulomatous inflammation, all showed clinical response to treatment on follow up.

CONCLUSIONS: Combination of microscopy, Gene xpert and mycobacterial cultures of EBUS-TBNA aspirate increases probability of making a definite diagnosis of mediastinal tuberculosis. Gene xpert seems to add value especially in cases that are on empiric treatment where cultures can be negative.

CLINICAL IMPLICATIONS: Gene xpert seems to add value especially in cases that are on empiric treatment where cultures can be negative.

DISCLOSURE: The following authors have nothing to disclose: Pattabhi Raman Vallandramam, Arjun Srinivasan, Mahadevan Sivaramakrishnan, Pavan Yadav

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