Algorithmic approach by endobronchial ultrasound-guided transbronchial needle aspiration for isolated intrathoracic lymphadenopathy: A study in a tuberculosis-endemic country

Chih Hsi Kuo, Shu Min Lin, Kang Yun Lee, Fu Tsai Chung, Po Hao Feng, Te Chih Hsiung, Yu Lun Lo, Chien Ying Liu, Han Pin Kuo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background/Purpose: Isolated intrathoracic lymphadenopathy (IT-LAP) is clinically challenging because of the difficult anatomic location and wide range of associated diseases, including tuberculosis (TB). Although sampling via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histopathology is a major development, there is still room for improvement. This study aimed to investigate an algorithmic approach driven by EBUS-TBNA and conventional bronchoscopy to streamline the management of IT-LAP. Methods: Eighty-three prospectively enrolled patients with IT-LAP were subjected to an EBUS-TBNA diagnostic panel test (histopathology, cytology, and microbiology) and underwent conventional bronchoscopy for bronchoalveolar lavage. The results were structured into an algorithmic approach to direct patient treatment, workup, or follow-up. Results: The diagnostic yields of EBUS-TBNA based on histopathology were similar for each disease entity: 77.8% for malignancy, 70.0% for TB, 75.0% for sarcoidosis, 80.0% for anthracosis, and 70.0% for lymphoid hyperplasia (p=0.96). The incidence of malignancy was 10.8% for total IT-LAP patients, and 12.0% and 33.7% for patients with TB and sarcoidosis, respectively. Thirty-five (42.2%) patients were symptomatic. The leading diagnosis was sarcoidosis (60%), followed by TB (20%), malignancy (11.4%), lymphoid hyperplasia (5.7%), and anthracosis (2.9%). By logistic regression analysis, granulomatous disease (odds ratio: 13.45; 95% confidence interval: 4.45-40.67, p

Original languageEnglish
Pages (from-to)527-534
Number of pages8
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume113
Issue number8
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Needles
Tuberculosis
Sarcoidosis
Anthracosis
Bronchoscopy
Hyperplasia
Neoplasms
Bronchoalveolar Lavage
Microbiology
Routine Diagnostic Tests
Cell Biology
Logistic Models
Odds Ratio
Regression Analysis
Lymphadenopathy
Confidence Intervals
Incidence
Therapeutics

Keywords

  • EBUS-TBNA
  • Intrathoracic lymphadenopathy
  • Malignancy
  • Tuberculosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Algorithmic approach by endobronchial ultrasound-guided transbronchial needle aspiration for isolated intrathoracic lymphadenopathy : A study in a tuberculosis-endemic country. / Kuo, Chih Hsi; Lin, Shu Min; Lee, Kang Yun; Chung, Fu Tsai; Feng, Po Hao; Hsiung, Te Chih; Lo, Yu Lun; Liu, Chien Ying; Kuo, Han Pin.

In: Journal of the Formosan Medical Association = Taiwan yi zhi, Vol. 113, No. 8, 2014, p. 527-534.

Research output: Contribution to journalArticle

@article{523d8fe0f6ac4f2381391b858811d624,
title = "Algorithmic approach by endobronchial ultrasound-guided transbronchial needle aspiration for isolated intrathoracic lymphadenopathy: A study in a tuberculosis-endemic country",
abstract = "Background/Purpose: Isolated intrathoracic lymphadenopathy (IT-LAP) is clinically challenging because of the difficult anatomic location and wide range of associated diseases, including tuberculosis (TB). Although sampling via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histopathology is a major development, there is still room for improvement. This study aimed to investigate an algorithmic approach driven by EBUS-TBNA and conventional bronchoscopy to streamline the management of IT-LAP. Methods: Eighty-three prospectively enrolled patients with IT-LAP were subjected to an EBUS-TBNA diagnostic panel test (histopathology, cytology, and microbiology) and underwent conventional bronchoscopy for bronchoalveolar lavage. The results were structured into an algorithmic approach to direct patient treatment, workup, or follow-up. Results: The diagnostic yields of EBUS-TBNA based on histopathology were similar for each disease entity: 77.8{\%} for malignancy, 70.0{\%} for TB, 75.0{\%} for sarcoidosis, 80.0{\%} for anthracosis, and 70.0{\%} for lymphoid hyperplasia (p=0.96). The incidence of malignancy was 10.8{\%} for total IT-LAP patients, and 12.0{\%} and 33.7{\%} for patients with TB and sarcoidosis, respectively. Thirty-five (42.2{\%}) patients were symptomatic. The leading diagnosis was sarcoidosis (60{\%}), followed by TB (20{\%}), malignancy (11.4{\%}), lymphoid hyperplasia (5.7{\%}), and anthracosis (2.9{\%}). By logistic regression analysis, granulomatous disease (odds ratio: 13.45; 95{\%} confidence interval: 4.45-40.67, p",
keywords = "EBUS-TBNA, Intrathoracic lymphadenopathy, Malignancy, Tuberculosis",
author = "Kuo, {Chih Hsi} and Lin, {Shu Min} and Lee, {Kang Yun} and Chung, {Fu Tsai} and Feng, {Po Hao} and Hsiung, {Te Chih} and Lo, {Yu Lun} and Liu, {Chien Ying} and Kuo, {Han Pin}",
year = "2014",
doi = "10.1016/j.jfma.2013.06.012",
language = "English",
volume = "113",
pages = "527--534",
journal = "Journal of the Formosan Medical Association",
issn = "0929-6646",
publisher = "Elsevier Science Publishers B.V.",
number = "8",

}

TY - JOUR

T1 - Algorithmic approach by endobronchial ultrasound-guided transbronchial needle aspiration for isolated intrathoracic lymphadenopathy

T2 - A study in a tuberculosis-endemic country

AU - Kuo, Chih Hsi

AU - Lin, Shu Min

AU - Lee, Kang Yun

AU - Chung, Fu Tsai

AU - Feng, Po Hao

AU - Hsiung, Te Chih

AU - Lo, Yu Lun

AU - Liu, Chien Ying

AU - Kuo, Han Pin

PY - 2014

Y1 - 2014

N2 - Background/Purpose: Isolated intrathoracic lymphadenopathy (IT-LAP) is clinically challenging because of the difficult anatomic location and wide range of associated diseases, including tuberculosis (TB). Although sampling via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histopathology is a major development, there is still room for improvement. This study aimed to investigate an algorithmic approach driven by EBUS-TBNA and conventional bronchoscopy to streamline the management of IT-LAP. Methods: Eighty-three prospectively enrolled patients with IT-LAP were subjected to an EBUS-TBNA diagnostic panel test (histopathology, cytology, and microbiology) and underwent conventional bronchoscopy for bronchoalveolar lavage. The results were structured into an algorithmic approach to direct patient treatment, workup, or follow-up. Results: The diagnostic yields of EBUS-TBNA based on histopathology were similar for each disease entity: 77.8% for malignancy, 70.0% for TB, 75.0% for sarcoidosis, 80.0% for anthracosis, and 70.0% for lymphoid hyperplasia (p=0.96). The incidence of malignancy was 10.8% for total IT-LAP patients, and 12.0% and 33.7% for patients with TB and sarcoidosis, respectively. Thirty-five (42.2%) patients were symptomatic. The leading diagnosis was sarcoidosis (60%), followed by TB (20%), malignancy (11.4%), lymphoid hyperplasia (5.7%), and anthracosis (2.9%). By logistic regression analysis, granulomatous disease (odds ratio: 13.45; 95% confidence interval: 4.45-40.67, p

AB - Background/Purpose: Isolated intrathoracic lymphadenopathy (IT-LAP) is clinically challenging because of the difficult anatomic location and wide range of associated diseases, including tuberculosis (TB). Although sampling via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histopathology is a major development, there is still room for improvement. This study aimed to investigate an algorithmic approach driven by EBUS-TBNA and conventional bronchoscopy to streamline the management of IT-LAP. Methods: Eighty-three prospectively enrolled patients with IT-LAP were subjected to an EBUS-TBNA diagnostic panel test (histopathology, cytology, and microbiology) and underwent conventional bronchoscopy for bronchoalveolar lavage. The results were structured into an algorithmic approach to direct patient treatment, workup, or follow-up. Results: The diagnostic yields of EBUS-TBNA based on histopathology were similar for each disease entity: 77.8% for malignancy, 70.0% for TB, 75.0% for sarcoidosis, 80.0% for anthracosis, and 70.0% for lymphoid hyperplasia (p=0.96). The incidence of malignancy was 10.8% for total IT-LAP patients, and 12.0% and 33.7% for patients with TB and sarcoidosis, respectively. Thirty-five (42.2%) patients were symptomatic. The leading diagnosis was sarcoidosis (60%), followed by TB (20%), malignancy (11.4%), lymphoid hyperplasia (5.7%), and anthracosis (2.9%). By logistic regression analysis, granulomatous disease (odds ratio: 13.45; 95% confidence interval: 4.45-40.67, p

KW - EBUS-TBNA

KW - Intrathoracic lymphadenopathy

KW - Malignancy

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=84904385518&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904385518&partnerID=8YFLogxK

U2 - 10.1016/j.jfma.2013.06.012

DO - 10.1016/j.jfma.2013.06.012

M3 - Article

C2 - 23856346

AN - SCOPUS:84904385518

VL - 113

SP - 527

EP - 534

JO - Journal of the Formosan Medical Association

JF - Journal of the Formosan Medical Association

SN - 0929-6646

IS - 8

ER -