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Aim: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. In this study, we aimed to evaluate the diagnostic contribution of EBUS-TBNA in the evaluation of intrathoracic tuberculous lymphadenitis. Methods: This retrospective study included 527 patients who had undergone EBUS-TBNA between December 2012 and December 2014. Final diagnosis of 527 patients and complications of the procedure were evaluated. Results from the procedures were recorded, including microscopy for acid-fast bacilli (AFB), cytology, mycobacterial cultures, standard bacterial cultures and the results of nucleic acid amplification techniques (NAAT). Final diagnosis of tuberculous lymphadenitis (TBLA) were evaluated and the sensitivity, negative predictive value (NPV) of EBUS-TBNA for TBLA were calculated. Results: Tuberculous was diagnosed in 28 patients (28/527, 5.2%). EBUS-TBNA diagnostic in 23 (82.1%) patients. In 5 TBLA patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Sensitivity of EBUS-TBNA for all microbiological tests was 53.5% in TBLA. The sensitivity for a composite microbiological and clinicopathological diagnosis of EBUS-TBNA was found 82.1 %. Sensitivity of NAAT was 14.8%. The negative predictive value (NPV) for microbiologic and composite clinicopathological investigation diagnosis was 97.8% and 99% respectively. Conclusions: EBUS-TBNA is a safe and effective procedure in the assessment of patients with TBLA. When microbiological tests and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates good diagnostic accuracy and NPV for the diagnosis of TBLA.

Introduction: There may be causes of mediastinal lymph node enlargement other than metastasis in cancer patients and anthracosis is one of them. Aim: The aim of this study was to evaluate if anthracotic lymph node detected by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a sign of benign conditions and excludes metastasis. Methods: Patients who underwent EBUS-TBNA for lung cancer staging or diagnosing mediastinal lymph node metastasis of ETM were included. Patients with EBUS-TBNA cytology reported as anthracotic pigments and also benign, malignancy or granulomatous inflammation were excluded. After EBUS-TBNA patients were underwent mediastinoscopy or radiological follow-up.If mediastinoscopic pathology was reported other than anthracosis or radiological follow-up showed lymph node enlargement,EBUS-TBNA was accepted as false negative. Results: Thirty one lung cancer and 19 ETM patients were included. Mediastinoscopy was performed in 23 lung cancer and 8 ETM patients. Remaing 8 lung cancer and 11 ETM patients were radiological follow-up. In lung cancer group, metastasis was reported with mediastinoscopy in 6 patients and 2 radiological follow-up patients had progression of lymph node enlargement. In ETM group only in 1 patient progression of lymph node enlargement was reported during radiological follow-up.As a result, EBUS-TBNA was false negative in 8 of 31 (25.8%) lung cancer patients and 1 of 19 (5.2%) ETM patients. Conclusion: In lung cancer patients anthracotic pigmentation of lymph nodes doesn9t exclude lymph node metastasis and mediastinoscopy should be performed before surgery. In extrathoracic malignancy patients, anthracotic pigmentation excludes metastasis.