PT  - JOURNAL ARTICLE
AU  - Robert Hackett
AU  - Graham Bothamley
TI  - Diagnosis of tuberculosis lymph node disease (TBLN): Problems with mediastinal disease
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p2696
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p2696.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p2696.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Introduction: TBLN requires material for culture and histological examination for diagnosis. This is especially important as drug-resistance increases. Current guidelines recommend empirical treatment after material for histology and culture has been obtained1.Method: A retrospective cohort review of all newly diagnosed cases of TBLN between January 1st 2009 and October 31st 2010 was performed against national standards [1]. Site, biopsy technique, reason for failure to biopsy and other investigations were recorded.Results: 39 cases were identified (26 extrathoracic, 13 intrathoracic). 22 had a fine needle aspirate (FNA) and 6 required open biopsy. 15 (39%) were commenced on treatment with no laboratory evidence of TB: 6 had no compatible histology or culture and 9 had no biopsy performed (8 mediastinal, 1 supraclavicular). Failures to biopsy were due to patient refusal (2) or technical difficulty in mediastinal biopsy (7).View this table:None had pulmonary evidence of TB on their chest x-ray. Ultrasound and CT confirmed caseation in 3 cases. Failure to improve after 2 months treatment led to open biopsies and diagnoses of follicular hyperplasia of the thymus and lipoma.Conclusion: An endoscopic biopsy under ultrasound (EBUS) service for mediastinal TB will improve adherence to guidelines, obtain material for culture and reduce risk of misdiagnosis and inadequate treatment.Reference:1. National Collaborating Centre for Chronic Conditions. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. 2006.