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Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculous Lymphadenitis^*

Semra Bilaçerolu, MD, FCCP; Özden Günel, MD; Nur Eris, MD; Ufuk Çarc, MD and Atul C. Mehta, MBBS, FCCP

^* From the Departments of Thoracic Medicine (Dr. Bilaçerolu) and Thoracic Surgery (Dr. Çarc), Izmir Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey; the Department of Pathology (Prof. Günel), Ege University School of Medicine, Izmir, Turkey; the Department of Bacteriology (Dr. Eris), National Institute of Hygiene, Izmir, Turkey; and the Department of Pulmonary and Critical Medicine (Dr. Mehta), The Cleveland Clinic Foundation, Cleveland, OH. Retired. Currently at the Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey.

Correspondence to: Semra Bilaçerolu, MD, FCCP, Associate Professor of Pulmonology, 6026 Sokak No: 197/22, 35560 Bostanl, Izmir, Turkey; e-mail: semrab{at}superonline.com

Study objective: To assess the role of transbronchial needle aspiration (TBNA) in diagnosing intrathoracic tuberculous lymphadenitis (TB-LA).

Methods: In a tertiary referral center for thoracic medicine and surgery, using a CT scan as a guide, transbronchial aspirates were obtained with a 19-gauge flexible histology needle in consecutively enrolled patients with sputum smears negative for acid-fast bacilli, and with isolated mediastinal or hilar adenopathy suspicious for tuberculosis (TB).

Results: Of 84 eligible patients who were all found to be HIV-negative, 63 (75%) cases of TB were diagnosed by TBNA (histology, 48 patients [76%]; cytology, 9 patients [14%]; and bacteriologic studies, 21 patients [33%; smear, 8 patients; culture, 17 patients]). TBNA was used to diagnose sarcoidosis in two patients, angioimmunoblastic lymphadenopathy in one patient, and Hodgkin lymphoma in one patient. In the 17 TBNA-negative patients, the results of transthoracic needle aspiration were positive in 12 patients (TB, nine patients; lung cancer, two patients; sarcoidosis, one patient), the results of mediastinoscopy were positive in three patients (TB, two patients; Hodgkin lymphoma, one patient), and the results of thoracotomy were positive in two patients (TB, two patients). Thus, 76 patients had TB, and all responded to anti-TB treatment. TB was corroborated by culture or histology of another specimen obtained from subsequently developed lesions in 40 patients (53%) during anti-TB treatment or posttreatment follow-up. TBNA was immediately diagnostic in 59 patients (78%), and exclusively in 52 patients (68%), among all bronchoscopic procedures and prebronchoscopic sputum studies. Sensitivity, specificity, positive and negative predictive values, and accuracy of TBNA for TB were 83%, 100%, 100%, 38%, and 85%, respectively. The only complication, self-limiting hemorrhage of < 30 mL volume, occurred in 65 patients (77%), with a volume of < 5 mL in 59 patients (70%).

Conclusion: TBNA is efficient and safe in the bacteriologic and pathologic diagnosis of intrathoracic TB-LA in HIV-negative and sputum smear-negative patients.

Key Words: diagnosis • intrathoracic • lymph node • transbronchial needle aspiration • tuberculosis