RT Journal Article
SR Electronic
T1 Improved and immediate diagnostics in mediastinal sarcoid lymphadenopathy via endobronchial ultrasound and quadruple testing
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3659
VO 40
IS Suppl 56
A1 Devesh Dhasmana
A1 Clare Bradley
A1 David Connell
A1 Peter George
A1 Aran Singanayagam
A1 Annette Jepson
A1 Clare Craig
A1 Corrina Wright
A1 Phillip Molyneaux
A1 Ajit Lalvani
A1 Graham Cooke
A1 Onn Min Kon
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P3659.abstract
AB Background: Mediastinal lymphadenopathy carries a wide differential diagnosis, including sarcoidosis, Tuberculosis (TB) and malignancy. Endobronchial Ultrasound-guided Transbronchial Nodal Aspiration (EBUS-TBNA) allows safe access to these nodes.Methods: 119 patients with mediastinal lymphadenopathy were referred to our tertiary centre for EBUS-TBNA between January 2010 and August 2011. Final diagnoses were used to explore the utility of the 4 tests performed through EBUS-TBNA: immunology (IGRA and/or Tuberculin Skin Test); cytology; microscopy/culture; and the GeneXpert MTB/RIF integrated TB PCR assay.Results: 27 patients (23% of cohort) were diagnosed with sarcoidosis based upon consistent clinical features and supportive TBNA. Cytology was predominantly non-caseating granulomata (24/27 (89%); 3/27 reactive). Immunology was negative in 22/25 (88%), positive in 3/25, not tested in two patients. Sensitivity and specificity for sarcoidosis with immunology alone was 87% and 69%, respectively, with specificity improved by cytology to 91%. GeneXpert was negative in all six further cases otherwise inconclusive by combined immunology/cytology testing (reactive appearances (3), immunology positive (3) or not done (2)). Three patients failed empirical TB treatment and were later re-diagnosed as sarcoidosis; all were PCR-negative.Conclusions: Combined immunology/TBNA-cytology data provide good specificity for sarcoidosis in patients with mediastinal lymphadenopathy. The inclusion of negative GeneXpert MTB/RIF in our cohort provided support in diagnosis for an additional 29% of cases. Quad-testing provides a fast-track and accurate diagnosis of sarcoidosis over TB.