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Endoscopy 2010; 42(6): 462-467
DOI: 10.1055/s-0029-1244133
Original article
 
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

R.  Puri1 , P.  Vilmann2 , R.  Sud1 , M.  Kumar1 , S.  Taneja1 , K.  Verma3 , N.  Kaushik4
  • 1Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
  • 2Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, Copenhagen University hospitals, Hellerup, Denmark
  • 3Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
  • 4Division of Gastroenterology, North Shore University Hospital, Manhasset, New York, USA
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Publication History

submitted 1 August 2009

accepted after revision 18 February 2010

Publication Date:
29 April 2010 (online)

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Background and study aims: Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim of the present study was to evaluate the role of EUS-FNA in isolated mediastinal lymphadenopathy in patients suspected of having tuberculosis.

Methods: Consecutive patients suspected of having tuberculosis with isolated mediastinal lymphadenopathy were included in a prospective study. Mediastinal lymphadenopathy was diagnosed on a contrast-enhanced computed tomography scan of the chest. Patients with concomitant lung parenchymal lesions were excluded. Previous attempts to diagnose the etiology of lymphadenopathy had failed in 69 % of patients. EUS-FNA was performed on an outpatient basis under conscious sedation. The sensitivity, specificity, and diagnostic accuracy of EUS-FNA were calculated.

Results: A total of 60 consecutive patients (mean age 39.8 years, 58 % males) with mediastinal lymphadenopathy were included. EUS confirmed the presence of mediastinal lymph nodes ranging in size from 8 mm to 40 mm (mean 26 mm) in all patients. EUS-FNA provided an adequate tissue sample in 54 patients during the first examination and repeat EUS-FNA was necessary in six patients. A final diagnosis was obtained by EUS-FNA in 42 patients (tuberculosis in 32, sarcoidosis in six, and Hodgkin’s disease in four patients). An additional 14 patients were treated for tuberculosis based on EUS-FNA and clinical features. Mediastinoscopy was required for diagnosis in the remaining four patients. EUS-FNA had an overall diagnostic yield of 93 %, sensitivity of 71 %, specificity of 100 %, and positive predictive value of 100 %.

Conclusion: EUS-FNA is an accurate, safe, and minimally invasive modality for evaluating isolated mediastinal lymphadenopathy in patients suspected of having tuberculosis in an endemic area with a high prevalence of tuberculosis.

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R. PuriMD 

Medanta Institute of Digestive and Hepatobiliary Sciences
Medanta, The Medicity

Sec-38, Gurgaon
Haryana – 122001
India

Fax: +91-124-4834111

Email: purirajesh69@gmail.comrajesh.puri@medanta.org