Abstract：
BACKGROUND: Mediastinal tubercular lymphadenitis is form of extrapulmonary tuberculosis [EPTB]. Clinical presentations are non-specific and diagnosis remains great clinical challenge. Microbiological and or histopathological evidences need to be present in order make diagnosis secure before initiation of anti-tubercular therapy (ATT). Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) provides tissue samples and aids management of this difficult to diagnosed entity. Current study describe role of EUS-FNA and Gene Xpert (GXP) in mediastinal tubercular lymphadenitis.
METHODS: Retrospective analysis of 72 patients with mediastinal lymphadenopathy who underwent EUS-FNA were carried out. Linear echoendoscope was used for evaluation mediastinum. EUS echo features of LNs were studied. Twenty two-G needle used was for aspiration tissue sample from pathologic lymph nodes (LNs). FNA samples were analysed by cytology, Acid-Fast Bacilli (AFB) staining and GXP study. All procedures were uneventful without any complications.
RESULTS: Forty two patients were diagnosed as tuberculosis (TB) following first EUS-FNA setting. Six patients underwent repeat EUS-FNA procedure following which another 3 were diagnosed as TB while remaining 3 started on empirical ATT based on additional supportive evidences. Forty five patients showed granulomatous inflammation on cytological analysis, AFB positivity noted in 16 (33.33%) patients while GXP in 26 (57.78%) patients. Rifampicin resistance detected in 3 ((6.25%) patients. All patients were followed clinico-radiologically for response to treatment.
CONCLUSIONS: Tuberculous lymphadenitis is the most common cause of mediastinal lymphadenopathy in TB endemic countries. EUS-FNA provides microbiological and histopathological/cytological evidences in this difficult to diagnosed EPTB and thereby avoids empirical ATT.
METHODS: Retrospective analysis of 72 patients with mediastinal lymphadenopathy who underwent EUS-FNA were carried out. Linear echoendoscope was used for evaluation mediastinum. EUS echo features of LNs were studied. Twenty two-G needle used was for aspiration tissue sample from pathologic lymph nodes (LNs). FNA samples were analysed by cytology, Acid-Fast Bacilli (AFB) staining and GXP study. All procedures were uneventful without any complications.
RESULTS: Forty two patients were diagnosed as tuberculosis (TB) following first EUS-FNA setting. Six patients underwent repeat EUS-FNA procedure following which another 3 were diagnosed as TB while remaining 3 started on empirical ATT based on additional supportive evidences. Forty five patients showed granulomatous inflammation on cytological analysis, AFB positivity noted in 16 (33.33%) patients while GXP in 26 (57.78%) patients. Rifampicin resistance detected in 3 ((6.25%) patients. All patients were followed clinico-radiologically for response to treatment.
CONCLUSIONS: Tuberculous lymphadenitis is the most common cause of mediastinal lymphadenopathy in TB endemic countries. EUS-FNA provides microbiological and histopathological/cytological evidences in this difficult to diagnosed EPTB and thereby avoids empirical ATT.
摘要：
背景：纵隔性结核性淋巴结炎是肺外结核的一种。临床表现是非特异性的，诊断仍然是巨大的临床挑战。在开始抗结核治疗（ATT）之前，需要提供微生物和/或组织病理学证据以确保诊断安全。内窥镜超声引导的细针抽吸术（EUS-FNA）提供了组织样本，并帮助管理这种难以诊断的实体。目前的研究描述了EUS-FNA和基因Xpert（GXP）在纵隔结核性淋巴结炎中的作用。
方法：回顾性分析72例纵隔淋巴结肿大患者行EUS-FNA。线性回声内窥镜用于评估纵隔。研究了LN的EUS回波特征。使用22-G针从病理淋巴结（LN）中抽吸组织样本。FNA样本通过细胞学分析，抗酸杆菌(AFB)染色和GXP研究。所有手术都顺利，没有任何并发症。
结果：42例患者在首次EUS-FNA设置后被诊断为结核病（TB）。6例患者接受了重复的EUS-FNA程序，随后另外3例被诊断为TB，而其余3例基于其他支持性证据开始进行经验性ATT。45例患者在细胞学分析中显示肉芽肿性炎症，16例（33.33%）患者出现AFB阳性，26例（57.78%）患者出现GXP阳性。在3例(6.25%)患者中检测到利福平耐药。对所有患者进行临床放射学随访，以了解对治疗的反应。
结论：结核性淋巴结炎是结核病流行国家纵隔淋巴结病的最常见原因。EUS-FNA在这种难以诊断的EPTB中提供了微生物学和组织病理学/细胞学证据，从而避免了经验性ATT。
方法：回顾性分析72例纵隔淋巴结肿大患者行EUS-FNA。线性回声内窥镜用于评估纵隔。研究了LN的EUS回波特征。使用22-G针从病理淋巴结（LN）中抽吸组织样本。FNA样本通过细胞学分析，抗酸杆菌(AFB)染色和GXP研究。所有手术都顺利，没有任何并发症。
结果：42例患者在首次EUS-FNA设置后被诊断为结核病（TB）。6例患者接受了重复的EUS-FNA程序，随后另外3例被诊断为TB，而其余3例基于其他支持性证据开始进行经验性ATT。45例患者在细胞学分析中显示肉芽肿性炎症，16例（33.33%）患者出现AFB阳性，26例（57.78%）患者出现GXP阳性。在3例(6.25%)患者中检测到利福平耐药。对所有患者进行临床放射学随访，以了解对治疗的反应。
结论：结核性淋巴结炎是结核病流行国家纵隔淋巴结病的最常见原因。EUS-FNA在这种难以诊断的EPTB中提供了微生物学和组织病理学/细胞学证据，从而避免了经验性ATT。
