Utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and additional value of cell block in the diagnosis of mediastinal lymphadenopathy: A one year study in a tertiary care hospital in north India

Background: Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is a technique using which mediastinal lymph nodes can be sampled under real time ultrasonographic visualisation. In addition cell block can be prepared leading to increased diagnostic yield. We conducted a retrospective study to evaluate the role of EBUS-TBNA FNA and cell block in patients of enlarged mediastinal and hilar lymph nodes. Methodology: We retrospectively studied 100 patients who underwent EBUS-TBNA FNA along with cell block preparation between January 2018 to December 2018. Bronchoalveolar lavage was also done. AFB staining and routine and fungal culture and sensitivity were done in all patients. The diagnostic accuracy of the FNA and cell block was analysed. Results: We found 80% sensitivity and 100% specificity of EBUS-TBNA FNA. Sensitivity and specificity of cell block were found to be 94% and 100% respectively. Diagnostic accuracy of EBUS-TBNA FNA for tuberculosis and malignancy was 66.7% and 90% respectively while that of cell block was 83.3% and 90% for tuberculosis and malignancy respectively. Both FNA and cell block had 100% diagnostic accuracy for sarcoidosis. Conclusions: In patients of mediastinal and hilar lymphadenopathy, EBUS-TBNA can be used as a procedure of choice as this is a safe procedure with reasonably high diagnostic accuracy. The sensitivity increases when EBUS aspirate is used along with cell block. Additional studies like IHC can be done on the cell block in patients of malignancy. Keywords: EBUS TBNA FNA; Cell block; Mediastinal lymphadenopathy; Tuberculosis; Sarcoidosis; Malignancy.