Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: A multicentre Australian experience

James Geake, Gary Hammerschlag, Phan Nguyen, Peter Wallbridge, Grant A. Jenkin, Tony M. Korman, Barton Jennings, Douglas F. Johnson, Louis B. Irving, Michael Farmer, Daniel P. Steinfort

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis. Methods: A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard. Results: One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25%). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62% (24/39 cases). Specificity was 100%. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89% [95% confidence intervals (CI), 82-93%] and 91% (95% CI, 84-94%) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98% (95% CI, 93-99%) and 98% (95% CI, 95-99%) respectively. Sensitivity for NAAT was 38% (95% CI, 18-65%). Conclusions: EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.

Original languageEnglish
Pages (from-to)439-448
Number of pages10
JournalJournal of Thoracic Disease
Volume7
Issue number3
DOIs
Publication statusPublished - 2015
Externally publishedYes

Keywords

  • Bronchoscopy
  • Culture
  • Endobronchial ultrasound (EBUS)
  • Minimally invasive
  • Mycobacteria
  • PCR
  • Tuberculosis (TB)

Cite this

Geake, James ; Hammerschlag, Gary ; Nguyen, Phan ; Wallbridge, Peter ; Jenkin, Grant A. ; Korman, Tony M. ; Jennings, Barton ; Johnson, Douglas F. ; Irving, Louis B. ; Farmer, Michael ; Steinfort, Daniel P. / Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis : A multicentre Australian experience. In: Journal of Thoracic Disease. 2015 ; Vol. 7, No. 3. pp. 439-448.
@article{aca457336d4c48578a1f2bc825c7b2dd,
title = "Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: A multicentre Australian experience",
abstract = "Background: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis. Methods: A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard. Results: One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25{\%}). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62{\%} (24/39 cases). Specificity was 100{\%}. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89{\%} [95{\%} confidence intervals (CI), 82-93{\%}] and 91{\%} (95{\%} CI, 84-94{\%}) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98{\%} (95{\%} CI, 93-99{\%}) and 98{\%} (95{\%} CI, 95-99{\%}) respectively. Sensitivity for NAAT was 38{\%} (95{\%} CI, 18-65{\%}). Conclusions: EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.",
keywords = "Bronchoscopy, Culture, Endobronchial ultrasound (EBUS), Minimally invasive, Mycobacteria, PCR, Tuberculosis (TB)",
author = "James Geake and Gary Hammerschlag and Phan Nguyen and Peter Wallbridge and Jenkin, {Grant A.} and Korman, {Tony M.} and Barton Jennings and Johnson, {Douglas F.} and Irving, {Louis B.} and Michael Farmer and Steinfort, {Daniel P.}",
year = "2015",
doi = "10.3978/j.issn.2072-1439.2015.01.33",
language = "English",
volume = "7",
pages = "439--448",
journal = "Journal of Thoracic Disease",
issn = "2072-1439",
number = "3",

}

Geake, J, Hammerschlag, G, Nguyen, P, Wallbridge, P, Jenkin, GA, Korman, TM, Jennings, B, Johnson, DF, Irving, LB, Farmer, M & Steinfort, DP 2015, 'Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: A multicentre Australian experience' Journal of Thoracic Disease, vol. 7, no. 3, pp. 439-448. https://doi.org/10.3978/j.issn.2072-1439.2015.01.33

Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis : A multicentre Australian experience. / Geake, James; Hammerschlag, Gary; Nguyen, Phan; Wallbridge, Peter; Jenkin, Grant A.; Korman, Tony M.; Jennings, Barton; Johnson, Douglas F.; Irving, Louis B.; Farmer, Michael; Steinfort, Daniel P.

In: Journal of Thoracic Disease, Vol. 7, No. 3, 2015, p. 439-448.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis

T2 - A multicentre Australian experience

AU - Geake, James

AU - Hammerschlag, Gary

AU - Nguyen, Phan

AU - Wallbridge, Peter

AU - Jenkin, Grant A.

AU - Korman, Tony M.

AU - Jennings, Barton

AU - Johnson, Douglas F.

AU - Irving, Louis B.

AU - Farmer, Michael

AU - Steinfort, Daniel P.

PY - 2015

Y1 - 2015

N2 - Background: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis. Methods: A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard. Results: One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25%). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62% (24/39 cases). Specificity was 100%. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89% [95% confidence intervals (CI), 82-93%] and 91% (95% CI, 84-94%) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98% (95% CI, 93-99%) and 98% (95% CI, 95-99%) respectively. Sensitivity for NAAT was 38% (95% CI, 18-65%). Conclusions: EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.

AB - Background: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis. Methods: A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard. Results: One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25%). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62% (24/39 cases). Specificity was 100%. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89% [95% confidence intervals (CI), 82-93%] and 91% (95% CI, 84-94%) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98% (95% CI, 93-99%) and 98% (95% CI, 95-99%) respectively. Sensitivity for NAAT was 38% (95% CI, 18-65%). Conclusions: EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.

KW - Bronchoscopy

KW - Culture

KW - Endobronchial ultrasound (EBUS)

KW - Minimally invasive

KW - Mycobacteria

KW - PCR

KW - Tuberculosis (TB)

UR - http://www.scopus.com/inward/record.url?scp=84928603437&partnerID=8YFLogxK

U2 - 10.3978/j.issn.2072-1439.2015.01.33

DO - 10.3978/j.issn.2072-1439.2015.01.33

M3 - Article

VL - 7

SP - 439

EP - 448

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 3

ER -