EBUS-TBNA in Sarcoidosis and Lymphoma: Exploring the Importance of Culture on Lymph Nodes

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an interesting tool in the investigation of sarcoidosis and lymphoma. Aims: To describe the performance of EBUS-TBNA in the assessment of sarcoidosis and lymphoma, with attention given to alternative infectious diagnoses. Methods: We retrospectively reviewed the data of 69 patients evaluated for sarcoidosis or lymphoma, who had EBUS-TBNA between January 2013 and December 2014 in our center. Efficacy of EBUS-TBNA was evaluated in terms of providing a specific diagnosis with pathological or microbiological analyses. Results: Mean age of patients was 55 years old (range 21-87), with 41(59.4%) males and 57(82.6%) Caucasians. Culture on lymph node was obtained in 47(68.1%). EBUS procedure yielded diagnosis in 42/69(60.9%): 25 sarcoidosis, 6 lymphomas, 5 cancers, 3 tuberculosis (TB), 1 Mycobacterium avium complex (MAC) and 2 other benign diseases. The 3 patients diagnosed with lymph node TB were from Bangladesh, Haiti and Togo. All 3 underwent EBUS-TBNA for suspicion of sarcoidosis (2 of them having radiologic features compatible with stage 1 and the other, with stage 2). Culture on lymph nodes showed TB in 3, while granulomas were detected in only 1 case. Bronchoalveolar lavage was non diagnostic for all. MAC was found in an immunocompromised Caucasian with mediastino-hilar lymphadenopathy and suspected lymphoma. Diagnosis was obtained from EBUS-TBNA material which showed non-caseating granulomas and culture positive for MAC. Conclusion: In suspected cases of sarcoidosis or lymphoma, culture on lymph nodes should be obtained with EBUS-TBNA, especially in patients from countries with high prevalence of TB.