Endobronchial Ultrasound in Suspected Non-Malignant Mediastinal Lymphadenopathy

Abstract

Background Endobronchial ultrasound (EBUS) bronchoscopy with transbronchial needle aspiration (TBNA) is a well-established tool in mediastinal staging in lung cancer and gains importance in exploration of non-malignant lymphadenopathy. The aim of this study was to evaluate the role of EBUS-TBNA in suspected non-malignant diseases.

Methods A retrospective, single-center, observation analysis of endobronchial ultrasound bronchoscopy procedures was performed in a university medical center between March 2013 and July 2015. All patients with suspected non-malignant mediastinal lymphadenopathy were included. Cytopathological and microbiological results of EBUS were compared to clinical diagnosis 6 months after procedure and performance of EBUS was contrasted to malignant indications.

Results During study period, 333 EBUS bronchoscopies in 315 patients with mediastinal lymphadenopathy were performed. 111 out of 315 (35 %) patients had neither primary signs nor history of a malignant disease, categorised as patients with suspected non-malignant disease. 245 lymph nodes were sampled (median size 15 mm [IQR10 – 19]). Preferred station for TBNA was lymph node station 7 (38 %). Cytopathological findings revealed non-specific inflammation (n = 81; 70 %), carcinoma (n = 7; 6 %), epithelioid cell granulomas (n = 20; 17 %). 7 samples (6 %) were non-representative. Microbiologic testing of lymph nodes identified 3 infections (Mycobacteria tuberculosis [n = 2] and Nocardia nova [n = 1]) relevant to antibiotic therapy. Minor adverse events were observed in 9 out of 115 (8 %) patients. Sensitivity of EBUS-TBNA intervention in suspected non-malignant disease was 76 % and specificity 96 %.

Conclusions EBUS-TBNA revealed a specific cause for suspected non-malignant lymphadenopathy in one-third of cases and was associated with excellent specificity. Predominant specific causes were granuloma, besides from tumor. In 3 patients pathogen could be isolated by TBNA.

Zusammenfassung

Einführung Die endobronchiale ultraschallgestützte transbronchiale Nadelaspiration (EBUS-TBNA) ist eine gängige Methode zum mediastinalen Lymphknotenstaging bei Patienten mit Lungenkarzinom und gewinnt an Stellenwert in der Untersuchung von gutartigen Lungenerkrankungen. Das Ziel der Studie war es, den Stellenwert der EBUS-TBNA bei nicht maligner mediastinaler Lymphadenopathie zu prüfen.

Methodik Wir führten eine retrospektive, monozentrische Beobachtungsanalyse von EBUS-TBNA-Prozeduren in einem Universitätsklinikum zwischen März 2013 und Juli 2015 durch. Alle Patienten mit vermeintlich nicht maligner mediastinaler Lymphadenopathie wurden eingeschlossen. Zytopathologische und mikrobiologische Ergebnisse der EBUS-TBNA Proben wurden 6 Monate nach der Untersuchung mit der klinischen Diagnose und malignen Indikationen verglichen.

Ergebnisse Während des Untersuchungszeitraumes wurden 333 EBUS-Bronchoskopien an 315 Patienten mit mediastinaler Lymphadenopathie durchgeführt. 111 von 315 (35 %) Patienten hatten weder primäre Zeichen noch eine Anamnese für eine Tumorerkrankung. Die Patienten wurden kategorisiert als Patienten mit vermeintlich nicht maligner Erkrankung. 245 Lymphknoten wurden punktiert (mediane Größe 15 mm [IQR 10 – 19]). Die bevorzugte Position für TBNA war Lymphknotenstation 7 (38 %). Zytopathologische Befunde ergaben unspezifische Entzündung (n = 81; 70 %), Karzinom (n = 7; 6 %), epitheloidzellige Granulome (n = 20; 17 %). 7 Proben (6 %) waren nicht repräsentativ. Die mikrobiologische Untersuchung der Lymphknotenpunktate wiesen 3 behandelbare Infektionen (Mycobacterium tuberculosis [n = 2] und Nocardia nova [n = 1]) nach. Leichtgradige Komplikationen wurden bei 9 von 115 (8 %) Patienten beobachtet. Die Sensitivität der EBUS-TBNA Untersuchung bei vermeintlich nicht maligner Lymphadenopathie lag bei 76 %, bei einer Spezifität bei 96 %.

Zusammenfassung In einem Drittel der Fälle ergab die EBUS-TBNA spezifische Ursachen für vermeintlich nicht maligne Lymphadenopathie. Häufigster Nachweis waren Granulome, gefolgt von Tumorerkrankung. Bei 3 Patienten konnten Erreger aus dem TBNA-Material isoliert werden.

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