Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy:...

The evaluation of mediastinal lymphadenopathy and masses poses a diagnostic challenge because of a myriad of possible etiologic causes; their proximity to numerous vital structures and the difficulty of access for biopsy. Computed tomography is an excellent modality for the initial evaluation of mediastinal lymph nodes (LNs). Tissue diagnosis is of paramount importance to confirm the diagnosis of mediastinal lymphadenopathy. Of various modalities including CT-guided biopsy, mediastinoscopy is considered a gold standard for tissue acquisition, but it is associated with considerable morbidity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method of sampling of mediastinal LNs and its role has been established in malignant cause of LN enlargement. However, its role in diagnosing benign diseases has not been studied much.

In a cross-sectional observational study, we performed EBUS-TBNA of 116 patients, and the sample was evaluated by various pathological modalities.

Most common LN sampled was subcarinal (68%). MTB gene Xpert was positive in 45 cases, and resistance was detected in 3 cases. Most common diagnosis was tuberculous lymphadenitis (67.9%). Only five of our patients had post-operative bronchospasm, while four had peri-operative hypoxia, which was managed with oxygen therapy.

EBUS-TBNA is an excellent modality for sampling mediastinal LNs, which is very safe and can be done on an OPD basis.