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Martin-Deleon R, Solarat B, Moisés J, Lucena CM, Fontana A, Marrades RM, Agustí C. EBUS-TBNA in Extrathoracic Malignancies: Diagnostic and Prognostic Implications. Lung 2022; 200:747-753. [PMID: 36309894 DOI: 10.1007/s00408-022-00584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE In patients with extrathoracic malignancies (EM) the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the assessment of abnormal mediastinal lymph nodes (MLN) is controversial. The aim of this study was to assess the diagnostic yield and prognostic significance of EBUS-TBNA in these patients. METHODS Retrospective analysis of patients with EM and abnormal MLN detected by Computed Tomography (CT) and/or Positron Emission Tomography (PET). RESULTS A total of 161 patients with EM and abnormal MLN were included (93 males, 58%). The most common EM was melanoma (19%) and gastrointestinal cancer (17%). Assessed lymph nodes were mediastinal in 70% of cases and hilar in 30%. The most frequently sampled lymph nodes were subcarinal (45%) and lower right paratracheal (21%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA for the diagnosis of malignancy were 88%, 100%, 100% and 87%, respectively. These values were similar regardless the type of EM except for head and neck tumors where the NPV was particularly low (67%). The diagnosis of neoplastic involvement by EBUS-TBNA implied a worse prognosis in terms of overall survival (p < 0.02) and cancer-specific survival (p < 0.001). CONCLUSIONS In patients with EM and abnormal MLN, EBUS-TBNA has a high diagnostic yield. However, the NPV decrease in patients with head and neck tumors. Neoplastic MLN detected by EBUS-TBNA has prognostic implications in these patients.
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Affiliation(s)
- Roberto Martin-Deleon
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain
| | - Belén Solarat
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain
| | - Jorge Moisés
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain
| | - Carmen M Lucena
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain
| | - Ainhoa Fontana
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain
| | - Ramón M Marrades
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain
| | - Carles Agustí
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic Barcelona, 170 Villarroel, 08036, Barcelona, Spain.
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Scano V, Fois AG, Manca A, Balata F, Zinellu A, Chessa C, Pirina P, Paliogiannis P. Role of EBUS-TBNA in Non-Neoplastic Mediastinal Lymphadenopathy: Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12020512. [PMID: 35204602 PMCID: PMC8871250 DOI: 10.3390/diagnostics12020512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Mediastinal lymphadenopathy is a condition in which one or more mediastinal lymph nodes are enlarged for malignant or benign causes, generally more than 10 mm. For a long time, the only way to approach the mediastinum was surgery, while in last decades endoscopic techniques gained their role in neoplastic diseases. At the present time, EBUS is the technique of choice for studying the mediastinum in the suspicion of cancer, while there are not strong indications in guidelines for the study of benign mediastinal lymphadenopathy. We reviewed the literature, looking for evidence of the role of EBUS in the diagnostics of non-neoplastic mediastinal lymphadenopathy, with special regard for granulomatous disease, both infectious and non-infectious. EBUS is a reliable alternative to surgery in non-neoplastic mediastinal lymphadenopathy, even if more evidence is needed for granulomatous diseases other than tuberculosis and sarcoidosis.
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Affiliation(s)
- Valentina Scano
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Correspondence: ; Tel.: +39-340-926-5637
| | - Alessandro Giuseppe Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Andrea Manca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Francesca Balata
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Carla Chessa
- Postgraduate School in Hospital Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Pietro Pirina
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Panos Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
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Kosmas K, Kosmas A, Riga D, Kyritsis C, Riga NG, Tsiambas E. Impact of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) on Lung Carcinoma Staging: A Retrospective Study. Cureus 2021; 13:e17963. [PMID: 34660150 PMCID: PMC8516022 DOI: 10.7759/cureus.17963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Lung cancer is the most common cancer in the world, both in terms of new cases and deaths. Almost a fifth of all cancer deaths worldwide are due to lung cancers. Our aim was to evaluate the utility of endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) for lymph node staging in patients with lung cancer. METHODS We performed a retrospective study on a total of 427 patients who underwent EBUS-TBNA sampling from January 2020 to December 2020 and a total of 610 lymph nodes were sampled. There were 322 men (mean age: 66.3 and range: 20-87) and 105 women (mean age: 65.9 and range: 18-81). RESULTS Cytological diagnosis revealed that 55 patients had adenocarcinoma, 28 squamous cell carcinoma, 43 neuroendocrine tumours, 34 non-small cell carcinoma not otherwise specified, 21 metastasis from extra-thoracic malignancy, 7 atypical cells suspicious for malignancy, and 239 patients had normal or reactive lymph nodes or non-neoplastic diagnosis. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91%, 88.3%, 100%, 100% and 89.2%, respectively. CONCLUSION EBUS-TBNA is a safe technique with high accuracy, sensitivity, specificity, PPV, and NPV. It is an excellent option for the diagnostic approach of patients with lymphadenopathy or intra-thoracic lesions as well as for the staging of malignancies.
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Affiliation(s)
- Konstantinos Kosmas
- Department of Cytopathology, 417 Army Equity Fund Hospital (NIMTS), Athens, GRC
| | - Andreas Kosmas
- 2nd Intensive Care Unit, General Hospital of Thessaloniki "George Papanikolaou", Exohi, Thessaloniki, GRC
| | - Dimitra Riga
- Pathology Department, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Christos Kyritsis
- Intensive Care Unit, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Nefeli Georgia Riga
- Department of Cytopathology, 417 Army Equity Fund Hospital (NIMTS), Athens, GRC
| | - Evangelos Tsiambas
- Department of Cytopathology, 417 Army Equity Fund Hospital (NIMTS), Athens, GRC
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Kalchiem-Dekel O, Hossain S, Gauran C, Beattie JA, Husta BC, Lee RP, Chawla M. An evolving role for endobronchial ultrasonography in the intensive care unit. J Thorac Dis 2021; 13:5183-5194. [PMID: 34527358 PMCID: PMC8411164 DOI: 10.21037/jtd-2019-ipicu-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
Endobronchial ultrasound (EBUS) bronchoscopy is an established minimally-invasive modality for visualization, characterization, and guidance of sampling of paratracheal and parabronchial structures and tissues. In the intensive care unit (ICU), rapidly obtaining an accurate diagnosis is paramount to the management of critically ill patients. In some instances, diagnosing and confirming terminal illness in a critically ill patient provides needed closure for patients and their loved ones. Currently available data on feasibility, safety, and yield of EBUS bronchoscopy in critically ill patients is based on single center experiences. These data suggest that in select ICU patients convex and radial probe-EBUS bronchoscopy can serve as useful tools in the evaluation of mediastinal lymphadenopathy, central airway obstruction, pulmonary embolism, and peripheral lung lesions. Barriers to the use of EBUS bronchoscopy in the ICU include: (I) requirement for dedicated equipment, prolonged procedure time, and bronchoscopy team expertise that may not be available; (II) applicability to a limited number of patients and conditions in the ICU; and (III) technical difficulty related to the relatively large outer diameter of the convex probe-EBUS bronchoscope and an increased risk for adverse cardiopulmonary consequences due to intermittent obstruction of the artificial airway. While the prospects for EBUS bronchoscopy in critically ill patients appear promising, judicious patient selection in combination with bronchoscopy team expertise are of utmost importance when considering performance of EBUS bronchoscopy in the ICU setting.
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Affiliation(s)
- Or Kalchiem-Dekel
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saamia Hossain
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cosmin Gauran
- Department of Anesthesia and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason A Beattie
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bryan C Husta
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert P Lee
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohit Chawla
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Khalid U, Akram MJ, Butt FM, Ashraf MB, Khan F. The Clinicopathological Features of Mediastinal Tuberculous Lymphadenitis in Cancer Patients and the Diagnostic Role of Endobronchial Ultrasound. Cureus 2021; 13:e15837. [PMID: 34327075 PMCID: PMC8301277 DOI: 10.7759/cureus.15837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Mediastinal lymphadenopathy in cancer patients can be of both malignant and non-malignant (including infectious) etiology. Tuberculosis (TB) is an important differential in this regard, particularly in regions with high TB endemicity. Objectives To determine the incidence and clinical characteristics of mediastinal tuberculous lymphadenitis (MTBLA) in cancer patients of a TB-endemic region, and the diagnostic role of endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) in such patients, utilizing both cytopathological and microbiological parameters for diagnosing TB. Materials and methods We retrospectively analyzed the relevant clinical data of all cancer patients diagnosed with MTBLA after undergoing EBUS-TBNA at our center, between July 2013 till July 2018 (total five years). The diagnostic yield, sensitivity and specificity of cytopathological and microbiological investigations (including TB culture and Mycobacterium tuberculosis Gene Xpert assay) for diagnosis of MTBLA were determined. Results Of the total 493 cancer patients, MTBLA was diagnosed in 54 (11%), with mean age of 48 ± 12 years, and predominantly male gender (59.3%). Thirty-three (61.1%) patients were clinically asymptomatic at the time of presentation, while cough was reported by 13 (24.7%) patients and weight loss, shortness of breath and fever by only six (11.1%), six (11.1%) and five (9.2%) patients, respectively. Total 53% had an underlying gastrointestinal malignancy. Chest imaging revealed bilateral versus unilateral hilar lymph node enlargement in 32 (59.3%) against 22 (40.7%) patients, respectively, while only 14 (25.9%) had accompanying lung parenchymal findings. Granulomatous TBNA cytology was detected in 41 (77.3%) patients, giving a diagnostic yield of 70.3% for MTBLA, with an estimated sensitivity and specificity of 79.2% and 99%, respectively. TB culture and Gene Xpert had a respective sensitivity of 48% and 53%, with the combined diagnostic yield of 64.8%. Treatment response was achieved in 51 (94%) patients, based on which EBUS was estimated to have sensitivity and specificity of 89% and 99% respectively, with no reported complications. Conclusion Mediastinal TB can have diverse manifestations among cancer patients and can often be clinically occult, with overlapping radiological impressions. EBUS-TBNA can serve as a safe and reliable diagnostic tool in this regard.
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Affiliation(s)
- Usman Khalid
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad J Akram
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem M Butt
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mohammad B Ashraf
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem Khan
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Mohan VF, Nangia V, Singh AK, Behl R, Dumeer N. Performance of cytology, acid-fast bacilli smear, gene Xpert and mycobacterial cultures in endobronchial ultrasound-transbronchial needle aspiration aspirate in diagnosing mediastinal tuberculous lymphadenitis. Lung India 2021; 38:122-127. [PMID: 33687004 PMCID: PMC8098901 DOI: 10.4103/lungindia.lungindia_128_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/12/2020] [Accepted: 11/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately. MATERIALS AND METHODS Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol. RESULTS Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%). CONCLUSION EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert.
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Affiliation(s)
- V Frank Mohan
- Department of Pulmonary Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
| | - Vivek Nangia
- Department of Pulmonary Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
| | - A K Singh
- Department of Pulmonary Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
| | - Rahul Behl
- Department of Pulmonary Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
| | - Nitin Dumeer
- Department of Pulmonary Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
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Kang W, Yu J, Du J, Yang S, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Dong Y, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A E, Du Y, Liu F, Cui W, Wang Q, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Yan X, Li L, Tang S. The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study. PLoS One 2020; 15:e0237753. [PMID: 32822367 PMCID: PMC7446809 DOI: 10.1371/journal.pone.0237753] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/01/2020] [Indexed: 12/28/2022] Open
Abstract
Tuberculosis (TB) remains a serious global public health problem in the present. TB also affects other sites (extrapulmonary tuberculosis, EPTB), and accounts for a significant proportion of tuberculosis cases worldwide. In order to comprehensively understand epidemiology of EBTB in China, and improve early diagnosis and treatment, we conducted a large-scale multi-center observational study to assess the demographic data and the prevalence of common EPTB inpatients, and further evaluate the prevalence of EPTB concurrent with Pulmonary tuberculosis (PTB) and the associations between multiple EPTB types and gender-age group in China. All consecutive age≥15yr inpatients with a confirmed diagnosis of EPTB during the period from January 2011 to December 2017 were included in the study. The descriptive statistical analysis included median and quartile measurements for continuous variables, and frequencies and proportions with 95% confidence intervals (CIs) for categorical variables. Multinomial logistic regression analysis was used to compare the association of multiple EPTB types between age group and gender. The results showed that the proportion of 15–24 years and 25–34 years in EPTB inpatients were the most and the ratio of male: female was 1.51. Approximately 70% of EPTB inpatients were concurrent with PTB or other types of EPTB. The most common of EPTB was tuberculous pleurisy (50.15%), followed by bronchial tuberculosis (14.96%), tuberculous lymphadenitis of the neck (7.24%), tuberculous meningitis (7.23%), etc. It was found that many EPTB inpatients concurrent with PTB. The highest prevalence of EPTB concurrent with PTB was pharyngeal/laryngeal tuberculosis (91.31%), followed by bronchial tuberculosis (89.52%), tuberculosis of hilar lymph nodes (79.52%), tuberculosis of mediastinal lymph nodes (79.13%), intestinal tuberculosis (72.04%), tuberculous pleurisy (65.31%) and tuberculous meningitis (62.64%), etc. The results from EPTB concurrent with PTB suggested that females EPTB inpatients were less likely to be at higher risk of concurrent PTB (aOR = 0.819, 95%CI:0.803–0.835) after adjusted by age. As age increasing, the trend risk of concurrent PTB decreased (aOR = 0.994, 95%CI: 0.989–0.999) after adjusted by gender. Our study demonstrated that the common EPTB were tuberculous pleurisy, bronchial tuberculosis, tuberculous lymphadenitis of the neck, tuberculous meningitis, etc. A majority of patients with pharyngeal/laryngeal tuberculosis, bronchial tuberculosis, tuberculosis of hilar/mediastinal lymph nodes, intestinal tuberculosis, tuberculous pleurisy, tuberculous meningitis, etc. were concurrent with PTB. Female EPTB inpatients were less likely to be at higher risk of concurrent PTB, and as age increasing, the trend risk of concurrent PTB decreased. The clinicians should be alert to the presence of concurrent tuberculosis in EPTB, and all suspected cases of EPTB should be assessed for concomitant PTB to determine whether the case is infectious and to help for early diagnosis and treatment.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jiajia Yu
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jian Du
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Song Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | | | - Jianxiong Liu
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Mingwu Li
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Jingmin Qin
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Wei Shu
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Peilan Zong
- Jiangxi Chest (third people) Hospital, Nanchang City, Jiangxi Province, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | - Yongkang Dong
- Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | | | - Qunyi Deng
- Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenge Han
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Meiying Wu
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Xinguo Zhao
- The Fifth People’s Hospital of Wuxi, Wuxi, China
| | - Lei Tan
- TB Hospital of Siping City, Siping City, Jilin Province, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Chao Zheng
- The First Affiliated of XiaMen University, Xiamen City, Fujian Province, China
| | | | - Xinjie Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Ertai A
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Yingrong Du
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Fenglin Liu
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | - Quanhong Wang
- Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, China
| | | | | | - Qingyao Xie
- Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyu Liu
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Peijun Tang
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Jian Zheng
- The Fifth People’s Hospital of Wuxi, Wuxi, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Xiangyang Yao
- The First Affiliated of XiaMen University, Xiamen City, Fujian Province, China
| | - Tong Ren
- Shenyang chest Hospital, Shenyang, China
| | - Yan Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Lei Wu
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Qiang Song
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Mei Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | | | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Yan
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Xinghua Shen
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, Chongqing, China
- * E-mail: (ST); (LL); (XY)
| | - Liang Li
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
- * E-mail: (ST); (LL); (XY)
| | - Shenjie Tang
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
- * E-mail: (ST); (LL); (XY)
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8
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Santos LM, Figueiredo VR, Demarzo SE, Palomino ALM, Jacomelli M. The role of endobronchial ultrasound-guided transbronchial needle aspiration in isolated intrathoracic lymphadenopathy in non-neoplastic patients: a common dilemma in clinical practice. ACTA ACUST UNITED AC 2020; 46:e20180183. [PMID: 32402011 PMCID: PMC7462701 DOI: 10.36416/1806-3756/e20180183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/20/2019] [Indexed: 12/25/2022]
Abstract
Objective: To determine the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in non-neoplastic patients with isolated intrathoracic lymphadenopathy (IL). Methods: This was a retrospective study of patients with isolated IL referred for EBUS-TBNA. We calculated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EBUS-TBNA in the diagnosis of granulomatous, reactive, and neoplastic lymphadenopathy. In cases of nonspecific granulomas, reactive lymphadenopathy, or inconclusive results, a definitive diagnosis was established by other diagnostic procedures or during a follow-up period of at least 18 months. Results: Among the 58 patients included in the study, EBUS-TBNA established a diagnosis of granulomatous disease in 22 (38%), reactive lymphadenopathy in 15 (26%), cancer in 8 (14%), and other diseases in 3 (5%). Results were inconclusive in 10 (17%), the diagnosis being established by other bronchoscopic procedures in 2 (20%) and by surgical procedures in 8 (80%). A final diagnosis of reactive lymphadenopathy was established in 12. Of those, 11 (92%) had their diagnosis confirmed during follow-up and 1 (8%) had their diagnosis confirmed by mediastinoscopy. In another 3, a final diagnosis of sarcoidosis or neoplasm was established. For the diagnosis of granulomatous disease, neoplasms, and reactive lymphadenopathy, EBUS-TBNA was found to have a sensitivity of 73%, 68%, and 92%, respectively; a specificity of 100%, 100%, and 93%, respectively; an accuracy of 86%, 93%, and 93%, respectively; a PPV of 100%, 100%, and 80%, respectively; and an NPV of 78%, 92%, and 98%, respectively. Conclusions: In non-neoplastic patients, granulomatous disease and reactive lymphadenopathy appear to be common causes of isolated IL. EBUS-TBNA shows promising results as a first-line minimally invasive diagnostic procedure. The results obtained by EBUS-TBNA can be optimized by examining clinical and radiological findings during follow-up or by comparison with the results obtained with other bronchoscopic methods.
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Affiliation(s)
- Lília Maia Santos
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sergio Eduardo Demarzo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Márcia Jacomelli
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Daher JA, Monzer HT, Abi-Saleh WJ. Limbic encephalitis associated with tuberculous mediastinal lymphadenitis. J Clin Tuberc Other Mycobact Dis 2019; 18:100129. [PMID: 31956698 PMCID: PMC6957786 DOI: 10.1016/j.jctube.2019.100129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction Limbic encephalitis represents an autoimmune disorder that is commonly associated with malignancies. It is also seen in association with infectious or systemic autoimmune diseases. The literature reports two case reports of limbic encephalitis associated with tuberculosis. Case Report We report the case of a 42 year-old male referred to our clinic for a non-resolving pneumonia. He was found to have a limbic encephalitis associated with mediastinal tuberculous lymphadenitis. The diagnosis was made on a needle aspirate from a mediastinal lymph node obtained through endobronchial ultrasound. A paradoxical radiological progression was noted during therapy. He was successfully treated by anti-tuberculous drugs with clinical and radiological improvement. Conclusion Limbic encephalitis is associated with tuberculosis and should be included as part of the central nervous system involvement with tuberculosis. Endobronchial ultrasound has been shown to be useful in the diagnosis of mediastinal tuberculous lymphadenitis.
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Affiliation(s)
- Jihad Abdallah Daher
- Diagnostic Radiology, Clemenceau Medical Center Affiliated with Johns Hopkins International, Beirut, Lebanon
| | - Hassan Talal Monzer
- Pulmonary and Critical Care Medicine, Clemenceau Medical Center Affiliated with Johns Hopkins International, Beirut, Lebanon
| | - Wajdy Joseph Abi-Saleh
- Pulmonary and Critical Care Medicine, Clemenceau Medical Center Affiliated with Johns Hopkins International, Beirut, Lebanon
- Corresponding author.
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Kim T, Jeon Y, Choi H, Lee JY, Kim J. Endobronchial fungal infection caused by Candida albicans with main bronchus obstruction: a case report. Oxf Med Case Reports 2019; 2019:omz055. [PMID: 31281663 PMCID: PMC6600126 DOI: 10.1093/omcr/omz055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/01/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
Endobronchial fungal infection (EBFI) is a rare form of pulmonary fungal infection that especially affects immunocompromised patients. Furthermore, EBFI resulting in obstruction of the main bronchus is extremely rare. With the development of bronchoscopic techniques, rare cases of EBFI have been reported. A 68-year-old female was referred to the Department of Pulmonology for confusion and obtundation. The patient was diagnosed with septic shock due to acute pyelonephritis followed by obstructive EBFI. We performed bronchoscopic biopsy and endobronchial aspiration for culture. Biopsy showed yeast-like fungus and Candida albicans grew in the culture. EBFI has been under-recognized because of difficulties in confirming the diagnosis. Endobronchial ultrasound-guided transbronchial needle aspiration and bronchoscopy are used to improve the diagnosis of thoracic infection, such as tuberculosis. The role of bronchoscopy in the diagnosis of infectious diseases of the trachea or main bronchi is expected to widen in the future.
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Affiliation(s)
- Taeyun Kim
- Department of Pulmonology, Kosin University Gospel Hospital, Busan, South Korea
| | - Yohan Jeon
- Department of Pathology, Kosin University Gospel Hospital, Busan, South Korea
| | - Hyunji Choi
- Department of Laboratory Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Jin Young Lee
- Department of Infectious Disease, Kosin University Gospel Hospital, Busan, South Korea
| | - Jehun Kim
- Department of Pulmonology, Kosin University Gospel Hospital, Busan, South Korea
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Li H, Li J, Wang X, Pang H, Di Y, Ren G, Li P, Liu C, Chen X, Kang X, Wang Y, Xia T. Promising Clinical Outcome With Long Term Follow-Up After Body Gamma Knife Stereotactic Radiosurgery for Patients With Early Stage Non-small Cell Lung Cancer. Front Oncol 2018; 8:618. [PMID: 30622929 PMCID: PMC6308148 DOI: 10.3389/fonc.2018.00618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/29/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: Stereotactic ablative radiosurgery (SRS) or stereotactic ablative body radiotherapy (SABR) is the standard treatment for patients with inoperable early stage non-small cell lung cancer (NSCLC), the body gamma knife SRS (ɤ-SRS) is a special SABR technology developed in China. This study prospectively assessed the clinical outcome, toxicity and cost following body ɤ-SRS for early stage NSCLC. Methods: From 2007 to 2010, a total of 29 patients with early stage NSCLC were prospectively enrolled in this study. The prescription dose for Planning Target Volume (PTV), Clinical Target Volume (CTV), and Gross Target Volume (GTV) were 50, 60, and 70 gray (Gy) in 10 fractions. Isodose curves of 50, 60, and 70% covered at least 100% of PTV, 90% of CTV, and 80% of GTV, respectively. The body ɤ-SRS was delivered 5 days per week and completed in 2 weeks. Results: Median follow-up time was 62.0 (range 11.1-140.3) months. 1-, 3-, 5-year OS rates were 93.1%, 72.0%, 60.3%; PFS rates were 86.2, 64.2 and 48.8%; and LR, RR, and DM rates were 10.9%, 21.4%, 29.0%. The median cost of the body ɤ-SRS during treatment was 4,838 (range 4,615-4,923) dollars and the median cost through 5 years was 36,960 (range 9920-56,824) dollars. Conclusion: With existing clinical data, the body ɤ-SRS is an effective treatment option for patients with medically inoperable early stage NSCLC or patients who do not prefer operation, as they may benefit from the minimized toxicity. Due to excellent cost effectiveness, the availability of the body ɤ-SRS will expand, especially in developing nations, and underdeveloped countries.
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Affiliation(s)
- Hongqi Li
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
- Medical School, People's Liberation Army General Hospital, Beijing, China
| | - Jing Li
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
- Medical School, People's Liberation Army General Hospital, Beijing, China
| | - Xuan Wang
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Haifeng Pang
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Yupeng Di
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Gang Ren
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Ping Li
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Chen Liu
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Xiao Chen
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Xiaoli Kang
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Yingjie Wang
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
| | - Tingyi Xia
- Department of Radiation Oncology, Airforce General Hospital PLA, Beijing, China
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Žemaitis M, Musteikienė G, Miliauskas S, Pranys D, Sakalauskas R. Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Cytological Smears and Cell Blocks: A Single-Institution Experience. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E19. [PMID: 30344250 PMCID: PMC6037240 DOI: 10.3390/medicina54020019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Abstract
Background and Objective: Endobronchial ultrasound (EBUS) is a minimally invasive endobronchial technique, which uses ultrasound along with a bronchoscope to visualize the airway wall and structures that are adjacent to it. Indications for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are samplings of mediastinal, hilar lymph nodes, and tumors adjacent to airway walls. EBUS-TBNA has been used in our clinic since 2009. The aim of the study is to evaluate the sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of cytological and histological specimens, and the safety of EBUS-TBNA in an unselected patient population that has been referred to our hospital. Materials and Methods: We have retrospectively analyzed the medical documentation of 215 patients who had EBUS-TBNA performed in our clinic from April 2009 to February 2014. Results: There were 215 patients who underwent EBUS-TBNA. A total of 296 lymph nodes were sampled. EBUS-TBNA was diagnostic in 176 (81.9%) cases of cytological, 147 (68.4%) cases of histological, and 191 (88.9%) cases of the combined evaluation. In the lung cancer patients, EBUS-TBNA cytology had a sensitivity of 72.9% and histology of 72.9%, and in the sarcoidosis group, it had a cytology of 55.8% and histology of 64.5%. As all positive cytology and histology specimens were assumed to be true positive, specificity and positive predictive value (PPV) were 100%. The sensitivity and diagnostic accuracy was significantly higher when cytology and histology specimens were combined, compared with cytology or histology results evaluated separately (p < 0.05) (for lung cancer 84.1% and for sarcoidosis 78.8%). The sensitivity and diagnostic accuracy of EBUS-TBNA procedures increased significantly over time, with increased experience. There were no complications with EBUS-TBNA in our clinical practice. Conclusions: EBUS-TBNA had a high diagnostic yield and was safe in the diagnosis of lung cancer and sarcoidosis. It was most informative when cytology and histology were combined. The informative value of EBUS-TBNA histology increased with our experience.
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Affiliation(s)
- Marius Žemaitis
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Greta Musteikienė
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Skaidrius Miliauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Darius Pranys
- Department of Pathological Anatomy, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Raimundas Sakalauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
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13
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Endobronchial Ultrasound Transbronchial Needle Aspiration in Thoracic Diseases: Much More than Mediastinal Staging. Can Respir J 2018; 2018:4269798. [PMID: 29686741 PMCID: PMC5857308 DOI: 10.1155/2018/4269798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/15/2018] [Accepted: 01/24/2018] [Indexed: 01/18/2023] Open
Abstract
Background and Objective EBUS-TBNA has revolutionized the diagnostic approach to thoracic diseases from a surgical to minimally invasive procedure. In non small-cell lung cancer (NCSLC) patients, EBUS-TBNA is able to dictate the consecutive therapy both for early and advanced stages, providing pathological diagnosis, mediastinal staging, and even adequate specimens for molecular analysis. This study reports on the ability of EBUS-TBNA to make different diagnoses and dictates the consecutive therapy in a large cohort of patients presenting different thoracic diseases. Methods All procedures performed from January 2012 to September 2016 were reviewed. Five groups of patients were created according to the main indications for the procedure. Group 1: lung cancer staging; Group 2: pathological diagnosis in advanced stage lung cancer; Group 3: lymphadenopathy in previous malignancies; Group 4: pulmonary lesions; Group 5: unknown origin lymphadenopathy. In each group, the diagnostic yield of the procedure was analysed. Non malignant diagnosis at EBUS-TBNA was confirmed by a surgical procedure or clinical and radiological follow-up. Results 1891 patients were included in the analysis. Sensitivity, negative predictive value, and diagnostic accuracy in each group were 90.7%, 79.4%, and 93.1% in Group 1; 98.5%, 50%, and 98.5% in Group 2; 92.4%, 85.1%, and 94.7% in Group 3; 90.9%, 51.0%, and 91.7% in Group 4; and 25%, 83.3%, and 84.2% in Group 5. Overall sensitivity, negative predictive value, and accuracy were 91.7%, 78.5%, and 93.6%, respectively. Conclusions EBUS-TBNA is the best approach for invasive mediastinal investigation, confirming its strategic role and high accuracy in thoracic oncology.
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14
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Maitra A, Kamil TK, Shaik M, Danquah CA, Chrzastek A, Bhakta S. Early diagnosis and effective treatment regimens are the keys to tackle antimicrobial resistance in tuberculosis (TB): A report from Euroscicon's international TB Summit 2016. Virulence 2017; 8:1005-1024. [PMID: 27813702 PMCID: PMC5626228 DOI: 10.1080/21505594.2016.1256536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/27/2016] [Indexed: 12/22/2022] Open
Abstract
To say that tuberculosis (TB) has regained a strong foothold in the global human health and wellbeing scenario would be an understatement. Ranking alongside HIV/AIDS as the top reason for mortality due to a single infectious disease, the impact of TB extends far into socio-economic context worldwide. As global efforts led by experts and political bodies converge to mitigate the predicted outcome of growing antimicrobial resistance, the academic community of students, practitioners and researchers have mobilised to develop integrated, inter-disciplinary programmes to bring the plans of the former to fruition. Enabling this crucial requirement for unimpeded dissemination of scientific discovery was the TB Summit 2016, held in London, United Kingdom. This report critically discusses the recent breakthroughs made in diagnostics and treatment while bringing to light the major hurdles in the control of the disease as discussed in the course of the 3-day international event. Conferences and symposia such as these are the breeding grounds for successful local and global collaborations and therefore must be supported to expand the understanding and outreach of basic science research.
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Affiliation(s)
- Arundhati Maitra
- Mycobacteria Research Laboratory, Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck, University of London, London, UK
| | - Tengku Karmila Kamil
- Mycobacteria Research Laboratory, Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck, University of London, London, UK
| | - Monisha Shaik
- Mycobacteria Research Laboratory, Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck, University of London, London, UK
| | - Cynthia Amaning Danquah
- Mycobacteria Research Laboratory, Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck, University of London, London, UK
| | - Alina Chrzastek
- Mycobacteria Research Laboratory, Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck, University of London, London, UK
| | - Sanjib Bhakta
- Mycobacteria Research Laboratory, Institute of Structural and Molecular Biology, Department of Biological Sciences, Birkbeck, University of London, London, UK
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15
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Jang JH, Jeon D, Kim YS, Cho WH, Yeo HJ. Superior Vena Cava Syndrome Due to Mediastinal Tuberculous Lymphadenitis. Korean J Fam Med 2017; 38:166-168. [PMID: 28572894 PMCID: PMC5451452 DOI: 10.4082/kjfm.2017.38.3.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 01/21/2023] Open
Abstract
Superior vena cava (SVC) syndrome refers to a medical emergency resulting from compression of the SVC. It requires early diagnosis and treatment, and is usually caused by malignant tumors; rarely, mediastinal tuberculous lymphadenitis can cause SVC syndrome. Here, we present a case study of an immunocompetent 61-year-old woman who presented with acute onset SVC syndrome and was diagnosed with tuberculous lymphadenitis on thoracotomy; the symptoms resolved with anti-tuberculosis therapy. This unusual case highlights the importance of the differential diagnosis in patients presenting with acute onset SVC syndrome; a timely diagnosis and appropriate treatment lead to complete recovery.
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Affiliation(s)
- Jin Ho Jang
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yun Seong Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Woo Hyun Cho
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hye Ju Yeo
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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16
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Li P, Zheng W, Liu H, Zhang Z, Zhao L. Endobronchial ultrasound-guided transbronchial needle aspiration for thyroid cyst therapy: A case report. Exp Ther Med 2017; 13:1944-1947. [PMID: 28565791 PMCID: PMC5443205 DOI: 10.3892/etm.2017.4213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/23/2016] [Indexed: 12/29/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is of limited usefulness for diagnosing thyroid disease, and few studies have reported its use in diagnosing and treating thyroid cysts. The present study investigated a unique case of diagnosis and treatment of a thyroid cyst by EBUS-TBNA. A 67-year-old male presented with back pain. Positron emission tomography/computed tomography scanning revealed low-density signals in the right lobe of the thyroid. Needle aspiration biopsies and drainage at this site was performed, and EBUS was used for guidance in diagnosing the thyroid cyst. A follow-up chest computed tomography scan indicated that the thyroid lesion had subsequently disappeared. The present study concludes that EBUS-TBNA provides an alternative approach for diagnosing and treating deep thyroid cysts located close to the airway. In all other cases, percutaneous needle aspiration or surgery should be the first choice.
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Affiliation(s)
- Peng Li
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Wei Zheng
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Hongbo Liu
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhenyong Zhang
- Department of Medical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110022, P.R. China
| | - Li Zhao
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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17
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Chen YB, Jiang JH, Mao JY, Huang JA. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions: Six cases reports and review of literature. Medicine (Baltimore) 2016; 95:e5249. [PMID: 27858883 PMCID: PMC5591131 DOI: 10.1097/md.0000000000005249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with isolated mediastinal or hilar lymphadenopathy, or peribronchial lesions, are common presentation to clinicians. Due to the difficulty in tissue sampling, the pathological diagnosis is not so easy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established, highly effective, minimally invasive technique for sampling. The current study was conducted to investigate the value of EBUS-TBNA in patients of solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions. METHODS Six patients with different pathological results diagnosed via EBUS-TBNA were retrospectively analyzed in this study. RESULTS All 6 patients of solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions underwent conventional flexible bronchoscopy before EBUS-TBNA, but only EBUS-TBNA was helpful for the finally definite diagnosis. No complication was observed. CONCLUSION EBUS-TBNA is a safe and highly effective diagnostic procedure for both benign and malignant diseases, especially for patients with solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions.
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Affiliation(s)
| | | | | | - Jian-An Huang
- Department of Respiratory Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Jian-An Huang, Department of Respiratory Medicine, the First Affiliated Hospital of Soochow University, 899#, Pinghai road, Suzhou 215000, China (e-mail: )
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18
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Kim D, Kim J, Lee D, Chang HS, Joh H, Koh WJ, Lee JH. Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor. Clin Endosc 2016; 49:564-569. [PMID: 27087646 PMCID: PMC5152778 DOI: 10.5946/ce.2016.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 12/11/2022] Open
Abstract
Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.
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Affiliation(s)
- Dongwuk Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juwon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Daegeun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Sung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunsung Joh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Eom JS, Mok JH, Lee MK, Lee K, Kim MJ, Jang SM, Na HJ, Song SE, Lee G, Jo EJ, Kim MH, Kim KU, Park HK. Efficacy of TB-PCR using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy. BMC Pulm Med 2015; 15:166. [PMID: 26710846 PMCID: PMC4693414 DOI: 10.1186/s12890-015-0162-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/15/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to perform mediastinal lymph node sampling. However, little information is available on polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA samples in patients with intrathoracic granulomatous lymphadenopathy (IGL). METHODS A retrospective study using a prospectively collected database was performed from January 2010 to December 2014 to evaluate the efficacy of the TB-PCR test using EBUS-TBNA samples in patients with IGL. During the study period, 87 consecutive patients with isolated intrathoracic lymphadenopathy who received EBUS-TBNA were registered and 46 patients with IGL were included. RESULTS Of the 46 patients with IGL, tuberculous lymphadenitis and sarcoidosis were diagnosed in 16 and 30 patients, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of TB-PCR for tuberculous lymphadenitis were 56, 100, 100, and 81%, respectively. The overall diagnostic accuracy of TB-PCR for tuberculous lymphadenitis was 85%. In addition, seven (17%) patients had non-diagnostic results from a histological examination and all of them had non-diagnostic microbiological results of an acid-fast bacilli smear and culture. Four (57%) of the seven patients with non-diagnostic results had positive TB-PCR results, and anti-tuberculosis treatment led to clinical and radiological improvement in all of the patients. CONCLUSIONS TB-PCR using EBUS-TBNA samples is a useful laboratory test for diagnosing IGL. Moreover, this technique can prevent further invasive evaluation in patients whose histological and microbiological tests are non-diagnostic.
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Affiliation(s)
- Jung Seop Eom
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea. .,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Jeong Ha Mok
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea. .,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea. .,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Kwangha Lee
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Min Ji Kim
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Sun Mi Jang
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Hae Jung Na
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Seung Eon Song
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea.
| | - Eun-Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Mi-Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Ki Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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