Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in a Geographical Region With Endemic Histoplasmosis Infection
Background and Objective: In a geographical area with high prevalence of calciﬁc granulomatous inﬂammation, calciﬁed lymph nodes may aﬀect the diagnostic adequacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to describe the diagnostic performance of EBUSTBNA in a region endemic of histoplasmosis related granulomatous inﬂammation. Methodology: A retrospective review was done for all patients referred for EBUS-TBNA over a 7-month period at 2 institutions. Computed tomographic (CT) chest studies were reviewed in a blinded manner by 2 radiologists. In parallel, CT images from 100 unselected sequential control patients were reviewed. Cytologic analysis of EBUS-TBNA aspirates was compared with a reference standard of deﬁnitive pathologic tissue diagnosis or a composite of Z6-month clinical follow-up. Results: The prevalence of calciﬁed lymph nodes in the 100 control patients was 56%. All 61 patients undergoing EBUSTBNA were included. In total, 97 lymph nodes (mean size=13.8mm) and 7 masses were biopsied. Deﬁnitive lymph node sampling was achieved in 51 of 61 patients (83%). The sensitivity, speciﬁcity, and positive and negative predictive values of EBUS-TBNA for malignancy (primary lung cancer staging, restaging, and reevaluation after cancer therapy, small cell lung cancer, lymphoma, and metastatic cancer) were 81%, 100%, 100%, and 84% respectively. On preEBUS CT chest scan, 60.6% had nodal calciﬁcation. The prevalence of cancer was not diﬀerent in those with and without nodal calciﬁcation (49%). There was no diﬀerence in frequency of deﬁnitive lymph node sampling in those patients with or without nodal calciﬁcation. Conclusion: In a geographical area with endemic histoplasmosis-related nodal calciﬁcation, there was no evidence of nodal calciﬁcation aﬀecting the frequency of EBUS-TBNA deﬁnitive lymph node sampling.
Shweihat, Yousef R., Samant, Rohan S., Joshi, Manish, Shah, Hemendra, Moore, Page C., Kennedy, Marcus P. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in a Geographical Region With Endemic Histoplasmosis Infection, Journal of Bronchology & Interventional Pulmonology: October 2010 - Volume 17 - Issue 4 - p 295-300 doi: 10.1097/LBR.0b013e3181fa6b2a