Diagnosis of Mediastinal Tuberculous Lymphadenopathy by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA)
Diagnosis of Mediastinal Tuberculous Lymphadenopathy by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA)
Although mediastinal tuberculous lymphadenopathy is not rare in adults of such an
 abnormality. Isolated mediastinal without a parenchymal lung lesion in adults is unusual with
 the incidence of 0.25%-5.8%. It occurs most commonly in Asian and black people, and presents
 a diagnostic problem. The definite diagnosis requires microbiology or pathology study.

 Cervical mediastinoscopy remained the gold standard to sample the mediastnial lymph nodes,
 but this technique can access lymph node station 1-4, 7 only. EBUS-TBNA allows the
 mediastinal lymph nodes to be targeted in the areas accessible to cervical mediastinoscopy,
 as well as some hilar nodes (lymph node stations 2-4, 7, 10-12). Currently, the main
 indication of EBUS-TBNA is the mediastinal nodal staging of NSCLC after recent meta-analyses
 established the comparable sensitivity and specificity of nodal staging by EBUS-TBNA and
 cervical mediastinoscopy. Theoretically, mediastnial tuberculous lymphadenopathy could be
 diagnosed by the method of EBUS-TBNA. Douglas F. Johnson was the first doctor to report 2
 cases of mediastinal tuberculous lymphadenopathy diagnosed by EBUS-TBNA in 2009. There are
 currently no much data on the use of this technique in this field. The investigators plan to
 perform a prospective single-center study to investigate the diagnostic efficacy of
 mediastinal tuberculous lymphadenopathy by sampling the culprit nodes via EBUS-TBNA.
 Concomitant sputum specimen for acid-fast stain and mycobacterial culture were collected as
 well.
Although mediastinal tuberculous lymphadenopathy is much more common as a manifestation of
 primary tuberculosis in children, the presentation in adults of such an abnormality is not
 rare. In a large series reported in 1959 by Lyons and coworkers, tuberculosis was the 5th
 commonest cause of mediastinal enlargement, accounting for 6% of 782 cases. Intrathoracic
 lymphadenitis had been found to be present in between 0.5% and 26%.

 However, isolated mediastinal without a parenchymal lung lesion in adults is unusual with the
 incidence of 0.25%-5.8%. It occurs most commonly in Asian and black people, and presents a
 diagnostic problem. Although chest CT findings such as nodes with central low attenuation and
 peripheral rim enhancement are suggestive, the definite diagnosis requires microbiology or
 pathology study.

 Cervical mediastinoscopy remained the gold standard to sample the mediastnial lymph nodes,
 but this technique can access lymph node station 1-4, 7 only. EBUS-TBNA allows the
 mediastinal lymph nodes to be targeted in the areas accessible to cervical mediastinoscopy,
 as well as some hilar nodes (lymph node stations 2-4, 7, 10-12).

 Kazuhiro Yasufuku had published the first report of rear-time EBUS-TBNA in evaluating
 mediastinal lymphadenopathy in 2004. Currently, the main indication of EBUS-TBNA is the
 mediastinal nodal staging of NSCLC after recent meta-analyses established the comparable
 sensitivity and specificity of nodal staging by EBUS-TBNA and cervical mediastinoscopy.
 Efficacy in evaluation of other disease processes such as sarcoidosis and lymphoma has also
 been established.

 Theoretically, mediastnial tuberculous lymphadenopathy could be diagnosed by the method of
 EBUS-TBNA. Douglas F. Johnson was the first doctor to report 2 cases of mediastinal
 tuberculous lymphadenopathy diagnosed by EBUS-TBNA in 2009. There are currently no much data
 on the use of this technique in this field.

 We plan to perform a prospective single-center study to investigate the diagnostic efficacy
 of mediastinal tuberculous lymphadenopathy by sampling the culprit nodes via EBUS-TBNA.
 Concomitant sputum specimen for acid-fast stain and mycobacterial culture were collected as
 well.
Inclusion Criteria:

 1. All patients with mediastinal lymphadenopathy of unknown etiology

 2. All patients signed informed consent before the procedure.

 Exclusion Criteria:

 1. Age less than 18 years

 2. Bleeding diathesis (INR>1.4 or platelet count<10k/mcl)