The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal lymphadenopathy

Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and endoscopic ultrasound with an echobronchoscope‐guided fine needle aspiration (EUS‐B‐FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children. Objective To describe the utility and safety of EBUS‐TBNA and EUS‐B‐FNA in children with mediastinal pathologies of unknown etiology. Design Chart review. Setting Pediatric Chest and Tuberculosis Clinics, Department of Pediatrics, AIIMS, New Delhi from May 2015 to March 2018. Patients Children <18 years of age with mediastinal pathologies of undefined etiology. Methods Case records of children who underwent EBUS‐TBNA and EUS‐B‐FNA were reviewed. Data on demographic profile, clinical features, laboratory investigations, the technique of EBUS‐TBNA/ EUS –B‐ FNA, complications, and findings were collected. Results Thirty children (19 males) with mean (SD) age of 9.6 (±3.5) years underwent endobronchial procedures. Median (IQR) weight(kg) and height(cm) were 29 (19.5, 35) and 134 (125, 150) respectively. Tuberculosis was the most common preprocedure clinical diagnosis (73.3%), followed by lymphoma (13.3%). Presenting features were fever (80%), cough (53.3%), hepatomegaly (13%), peripheral lymphadenopathy (21.7%), and positive tuberculin skin test (63.3%). Approximately one fourth were on antitubercular therapy without definite evidence of TB. Conscious sedation was used for the procedures: midazolam and fentanyl (n = 22), propofol (n = 8). Transesophageal, transtracheal, and both routes were used in 20 (66.6%), 7 (23.3%), and 3 (10.1%), respectively. Lymph‐nodes were sampled in 24 children (subcarinal in 16, right paratracheal in 4 and both in 4). Mean (SD) size of lymph node (in cm) on EBUS was 1.93(±0.5) and median (IQR) number of FNAC needle passes per node were 2 (2, 4). The diagnosis was confirmed in 11 (36.6%, tuberculosis in 10 by GeneXpert/ MGIT/ cytopath and lymphoma in one) patients. Only 3.3% had a minor complication. Conclusion EBUS‐TBNA and EUS‐B‐FNA are helpful in children with undiagnosed mediastinal pathology with fair diagnostic yield and excellent patient safety profile.

Section: Introductionmentioning

confidence: 99%

Utility and safety of endobronchial ultrasound‐guided transbronchial needle aspiration and endoscopic ultrasound with an echobronchoscope‐guided fine needle aspiration in children with mediastinal pathology

Gulla

Gunathilaka

Jat

et al. 2019

“…Due to a high complication rate and morbidity associated with these procedures in adults, there has been a shift towards minimally invasive bronchoscopic procedures. Conventional transbronchial needle aspiration (TBNA) while used frequently in adults, has been sparingly reported in children . In recent years, conventional TBNA has largely been replaced by endoluminal ultrasound‐guided techniques (both transesophageal and transtracheal) .…”

Section: Introductionmentioning

confidence: 99%

A multicenter study on the utility and safety of EBUS‐TBNA and EUS‐B‐FNA in children

Dhooria

Madan

Pattabhiraman

et al. 2016

“…Bronchoalveolar lavage and endobronchial biopsy were done for culture (MTB, Norcardia, NMTB, and fungi) and cytology. Transbronchial needle aspiration biopsy (TBNA) was performed . All of these were negative.…”

Section: Casementioning

confidence: 99%

“…The granulomatous form of FM mostly follows chronic infections; histoplasmosis being the commonest cause . A handful of adult cases have been published where Mycobacterium tuberculosis (MTB) is associated with FM but rarely in children . This case reports the clinical course of a child suffering from FM possibly associated with MTB, the interventions attempted and the unfavorable outcome.…”

Section: Introductionmentioning

confidence: 99%

Lethal fibrosing mediastinitis in a child possibly due to Mycobacterium tuberculosis

Goussard

Gie

Janson

2018

Fibrosing mediastinitis (FM) is a rare benign disease resulting from an excessive fibro-inflammatory reaction in the mediastinum that can compress and occlude mediastinal structures. There is a granulomatous and a diffuse non-granulomatous form of FM. We present a case of granulomatous FM following possible tuberculosis in a young child who presented with severe compression of the airways, pulmonary artery and the superior vena cava (SVC), unresponsive to treatment, resulting in death. Bronchoscopic findings included concentric narrowing and mucosal hyperaemia of the tracheobronchial airways. This case raises awareness of this rare complication and the limited treatment options available.