The efficiency of transbronchial needle aspiration under the guidance of endobronchial ultrasound in the diagnosis of isolated mediastinal or hilar lymphadenopathy

This study aims to determine the diagnostic efficiency of the process in patients who underwent transbronchial needle aspiration under the guidance of endobronchial ultrasound (EBUS-TBNA) due to isolated mediastinal or hilar lymphadenopathy (IMHL) and to analyze clinic and sonographic findings that can be used to differentiate lymph node pathologies identified in the etiology. In our study, the patients who underwent the EBUS-TBNA procedure to investigate the etiology of IMHL in the last 3 years were included. The demographic data, symptoms upon application, comorbid diseases that can be related to lymphadenopathy, and EBUS findings were recorded from the files of the patients. In this retrospective study, 120 patients who met the criteria in the study were evaluated. 66 (55%) of the patients were females while 54 (45%) of the patients were males. The mean age of the patients was 54,4 ± 14,3. Of 120 patients, it was determined that 88 (73,3%) of the patients were diagnosed by using the EBUS-TBNA procedure. It was determined that 54 of the patients had granulomatous diseases while 21 of the patients had malignant diseases in addition to 13 patients who had anthracotic lymph nodes. According to these results, it was determined that the sensitivity of EBUS-TBNA was 89,8% in addition to the negative predictive value of 68,7% and the diagnostic efficiency of 91,6%. Furthermore, it was observed that the patients with reactive lymph nodes had significantly higher numbers of comorbid diseases (77,3% versus 19,4%; p<0,001) and lower numbers of lymph node stations (1,6 ± 0,8 versus 2,7 ± 0,9; p<0,001) compared to patients with pathologic lymph nodes. When patients with granulomatous diseases were compared to patients with carcinoma and patients with lymphoma, it was observed that patients with anthracotic lymph nodes were statistically significantly older (p=0,001, p=0,028, and p=0,02, respectively) while mostly consisting of females (11/13, p<0,001). EBUS-TBNA procedure had high performance in the differential diagnosis of IMHL. Furthermore, it was observed that the numbers and sizes of lymph node stations provided valuable insight in achieving the differential diagnosis while patients with anthracotic lymph nodes were generally elderly females. Before invasive sampling is performed in patients with reactive lymph nodes, maintaining clinic follow-up procedures can be an efficient approach. Keywords: Mediastinal lymphadenopathy, endobronchial ultrasound, reactive lymph node, anthracotic lymph node, granulomatous disease