Rapid Diagnosis of Mediastinal Tuberculosis with Polymerase Chain Reaction Evaluation of Aspirated Material Taken by Endobronchial Ultrasound–Guided Transbronchial Needle Aspiration

Abstract

As a result, the use of M. tuberculosis PCR in the EBUS-TBNA specimens provides a rapid and an accurate diagnosis of TB. Therefore, we recommend the use of M. tuberculosis PCR in the EBUS-TBNA specimens as a rapid diagnostic method for mediastinal lymphadenopathies in patients with suspected TB.

The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal tuberculous lymphadenitis

“…In our study, the sensitivity and specificity of NAATs was 14.2% and 99.6%, and the results were similar to those of other studies (11,(15)(16)(17). It is remarkable that in our study only one out of 4 patients with positive EBUS-TBNA-obtained AFB and two out of 13 patients with positive EBUS-TBNA-obtained culture for M. tuberculosis had positive PCR.…”

“…In our study, AFB positivity was 14.3% and culture positivity was 46.4% in materials obtained from EBUS-TBNA. In published data, AFB detection ranged from 0.8% to 48.5%, while culture positivity ranged from 20% to 62% (10)(11)(12)(13)(14)(15)(16)(17). When these results are compared with fineneedle aspiration results for peripheral lymph nodes and EUS studies for mediastinal lymph nodes, sensitivities and specificities are similar (2,(18)(19)(20)(21).…”

“…In our study, when microbiological and cytopathological results were evaluated together, EBUS-TBNA was diagnostic in 21 cases, and the sensitivity of EBUS-TBNA increased to 87.5%. In previous studies, this sensitivity varied between 70% and 90% (10)(11)(12)(13)(14)(15)(16)(17).…”

“…In previous studies, the incidence of necrotizing granulomatous inflammation varied between 27% and 66.7% (10)(11)(12)(13)(14)(15)(16).…”

“…In published studies, PCR has a sensitivity of 17%-100% and specificity of 67%-100% in the diagnosis of tuberculous lymphadenitis (23). For EBUS-TBNA-obtained material NAAT positivity was between 18.2% and 56.7% (11,(15)(16)(17). In a policy update published by the WHO, Xpert MTB/RIF was proposed as a replacement test for the usual practice (including conventional microscopy, culture, or histopathology) for testing specific nonrespiratory specimens (lymph nodes and other tissues) from patients with suspected tuberculosis (24).…”