RESUMO
Objective: To evaluate the diagnostic accuracy of Endo-bronchial ultrasound guided transbronchial needle Aspiration in patients with mediastinal lymphadenopathy and mass lesions especially in the context of granulomatous versus non granulomatous lung disorders
Study Design: Open label, unblended prospective observational cohort
Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital Rawalpindi, from July 2015 to Mar 2016
Patients and Methods: All patients presented during study periods with meditational lymphadenopathy or lesions in which the initial bronchoscopy did not reveal any diagnosis were included in the study. Endobronchial ultrasound-guided transbronchial needle aspiration was performed in the bronchoscopy suit under conscious sedation and local anesthesia. Rapid on site evaluation was available for most of the cases. The procedure was performed using an integrated fibreoptic bronchoscopy with 22G TBNA needle by an experienced Bronchoscopist. The data was analyzed by using SPSS version 21
Results: A total of 53 patients with mean age of 44 years underwent endobronchial ultrasound-guided transbronchial needle aspiration for evaluation of meditational or hilar lesions between Jul 2015 to Apr 2016. There were 43 [81.1percent] male and 10 [18.8percent] female patients. A total of 108 Lymph nodes were sampled in 53 patients, rapid on site evaluation was available in 41 [77.3percent] patients. Adequate representative sample could be obtained in 45 of 53 [84.9percent] patients. The overall diagnosis were chronic granulomatous lesion in 27 [50.9percent] patients, squamous cell carcinoma in 10 [18.8percent], lymphoproliferative disorder in 2 [3.7percent], thymoma in 1 [1.3percent] and reactive hyperplasia in 5 [9.4percent] of cases. No major complication of the procedure was observed
Conclusion: End bronchial ultrasound-guided transbronchial needle aspiration was found useful diagnostic modality for lymph nodes sampling in patients with lymphadenopathy and mass like lesions in mediastinum
RESUMO
To assess the diagnostic yield of bronchial washings for detection of AFB in clinically suspected new smear negative cases of pulmonary tuberculosis. Non-interventional analytical Combined Military Hospital Quetta and Fatima Jinnah General and Chest Hospital Quetta, Pakistan. From outpatient departments of these two hospitals, fifty smear negative new cases of pulmonary tuberculosis [PTB] were included in whom diagnosis was made on the basis of clinical findings and x-ray. All these patients underwent fibrotic bronchoscopy for collection of bronchial washings from the lobe1 segment where lesions were evident on plain chest x-ray. These secretions were sent to microbiology department for preparation of smear and detection of acid-fast bacilli [AFB] with Zeihl- Nelson staining. Out of 50 patients, 33 [66%] were males and 17 [34%] were females. On smear of bronchial washings, 21 [42%] were positive for AFB while 29 [58%] were still negative. Bronchial washings were found to have better diagnostic yield of AFB on direct smears as compared to standard sputum smear examinations. Moreover, clinical suspicion of PTB is not always correct, as significant numbers of clinically suspected cases did not yield AFB in bronchial washings. Where feasible, fibreoptic bronchoscopy and direct washings should be employed for confirming the clinical impression of PTB in smear negative cases