Role of Endobronchial Ultrasound Guided real time Transbronchial Needle Aspiration in Mediastinal Lymphadenopathy: A Case Series

Introduction: Mediastinal lymphadenopathy is expected to be the common mediastinal masses because this is caused by high prevalent diseases like tuberculosis, lung cancer metastasis, lymphoma and sarcoidosis etc. Mediastinal lymphadenopathies are difficult to biopsy since they are nearer to major vessels and airways and located commonly in the middle compartment. Hence mediastinal lymphadenopathy is under represented in many studies since unable to obtain tissue diagnosis. The newer techniques EBUS and EUS are made easier to approach the mass like lymphadenopthy in middle mediastinum with less complication. Objective: To know the effectiveness of real-time EBUS in the evaluation of mediastinal lymphadenopathy. Methodology: In our study 50 cases of mediastinal lymphadenopathy diagnosed by CT scan chest which were subjected to EBUS guided real time TBNA of mediastinal nodes. TBNA Specimens were sent for histopathological examinations and reports were collocated and analyzed. Results: Among 50 cases of mediastinal lymphadenopathy, arrived diagnosis in EBUS TBNA in 42 cases and inconclusive results in other 8 cases. Among 42 cases, tuberculosis in 17 cases [34%], malignancy in 16 cases [32%], sarcoidosis in 8 cases [16%], sub acute inflammation in 1 case [2%]. Conclusion: Before the advent of EBUS, Percutaneous transthoracic needle biopsy/FNAC (under CT or ultrasound guidance) or surgical procedures [VATS or Mediastinoscopy] were considered as the initial method of choice in evaluation of mediastinal lesions. EBUS techniques has demonstrated utility in the diagnosis of mediastinal lymphadenopathy secondary to malignancy, tuberculosis and sarcoidosis and easier and lesser complication than more invasive procedures like VATS or mediastinoscopy

Comparison of CBNAAT, AFB Culture and histopathology of pleural biopsy specimens in suspected tuberculous pleural effusions undergoing pleural biopsy - Case series

Introduction: Tuberculous pleural effusion is the second most common extrapulmonary tuberculosisl. Due to its paucibacillary nature, it is difficult to demonstrate tubercle bacilli in pleural fluid by a standard AFB staining and culture, thus leading to a large number of cases being undiagnosed or misdiagnosed2. According to RNTCP, the sensitivity of CBNAAT compared to a liquid culture is high in biopsy specimens3. However, the preferred specimen for diagnosing a pleural TB is a pleural tissue8. To date, the studies on evaluation of CBNAAT which are performed on pleural tissue are only few. Objective: To compare the yield of CBNAAT, AFB culture and histopathology of pleural tissue in suspected tuberculous pleural effusions undergoing pleural biopsy. Methodology: A case series comprising 20 patients with presumptive pleural TB underwent thoracoscopy guided pleural biopsy in the department of respiratory medicine. Specimens were sent for CBNAAT, AFB culture and for histopathological examinations. Comparative analysis of these reports were carried out. Results: Out of 20 cases, 11 were microbiologically diagnosed as tuberculous pleural effusion. Mycobacterium tuberculosis was detected by CBNAAT in 10 cases, culture showed AFB growth in 7 cases. Histopathological examination of pleural biopsy showed granulomatous inflammation in about 13 cases. Conclusion: CBNAAT is the most rapid, highly sensitive test compared to AFB culture and more confirmatory to diagnosis microbiologically confirmed tuberculosis compared to HPE