Value of real-time endobronchial ultrasound-guided transbronchial needle aspiration.

AIM: The diagnostic value of real-time convex-probe endobronchial ultrasound (CP-EBUS)-guided transbronchial needle aspiration (TBNA) in mediastinal pathologies, and the factors influencing it are not clearly known. This study has been designed to examine factors affecting the efficacy and diagnostic value of CP-EBUS-TBNA. METHODS: Patients (n = 321) with mediastinal mass or enlarged lymph node in the mediastinum, participated in this study, conducted between April 2007 and May 2009. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. Histopathologic (in all samples) and microbiologic (in 151 patients' samples) evaluations were carried out. Biopsy using an appropriate surgical method was taken when the result of the TBNA procedure was nondiagnostic. Thirty-four patients were excluded from the analysis due to several reasons. The diagnostic efficacy of the procedure was analyzed in the remaining 287 patients. RESULTS: The diagnostic rate was 92% (89.7% for the benign diseases and 92.6% for the malignant diseases (P = 0.59)). In granulomatous diseases, the rate was 96% for sarcoidosis and 79% for tuberculosis (P = 0.002). Patients in whom only one lymph node was sampled and in whom two or more lymph nodes were sampled had a diagnostic rate of 85% and 95%, respectively (P = 0.03). When left hilar nodes were sampled, a higher diagnostic rate was achieved (P = 0.01). CONCLUSIONS: CP-EBUS-guided TBNA has a high diagnostic rate. Sampling of at least two separate lymph nodes and the discovery of left hilar station in these lymph nodes increase the rate of diagnosis.

Role and outcome of surgery for pulmonary tuberculosis.

The need and outcome of surgical intervention in patients with pulmonary tuberculosis were assessed retrospectively. Between 1993 and 2003, 72 major surgical procedures were performed in 57 patients with pulmonary tuberculosis. There were 44 males and 13 females with a mean age of 34 years. Indications for surgery were: trapped lung in 18 (31.6%), multidrug-resistant tuberculosis in 10 (17.5%), aspergilloma in 10 (17.5%), destroyed lung in 5 (8.8%), massive hemoptysis in 4 (7%), bronchopleural fistula in 3 (5.3%), persistent cavity in 2 (3.5%), and undiagnosed nodule in 5 (8.8%) patients. The most common procedure was lobectomy (31.9%). Other procedures included decortication, wedge resection, pneumonectomy, segmentectomy, and myoplasty. There were 28 complications in 18 patients, including prolonged air leak in 12 (21.1%), residual space in 7 (12.3%), empyema in 5 (8.8%), hematoma in 2 (3.5%), chylothorax and bronchopleural fistula in 1 (1.8%) each. There was no operative death, but one patient died from sepsis late in the follow-up period (mortality, 1.8%). As morbidity and mortality rates are acceptable, surgical intervention can be considered safe and effective in patients with pulmonary tuberculosis.

Analysis of surgical treatment for pulmonary aspergilloma.

Surgery for pulmonary aspergilloma is reputed to be risky. The results of surgical treatment of pulmonary aspergilloma in 41 patients between 1988 and 2003 were evaluated retrospectively. Hemoptysis occurred in 31 patients (75.6%) and it was massive (> 300 mL in 24 hr) in 3. The underlying lung disease was tuberculosis in 35, bullous lung disease in 2, hydatid cyst in 2, and lung carcinoma in 2 patients. Lobectomy, bilobectomy, wedge resection, and pneumonectomy were performed in 27, 4, 6, and 4 patients respectively. The postoperative complication rate was 24.4%. One patient, who had a right pneumonectomy, died due to respiratory failure; the mortality rate was 2.4%. Recurrent hemoptysis was observed in only one patient. Early surgical treatment of patients with pulmonary aspergilloma resulted in a satisfactory outcome with acceptable morbidity, low mortality, and effective prevention of recurrent hemoptysis. Pneumonectomy has a high morbidity, thus it should be avoided if possible.