Free Paper Presentation : OS-61 ; The Role of Routine AFB Culture and MTB PCR During EBUS-TBNA in Intermediate Tuberculosis Prevalence Country

Background: Tuberculous lymphadenitis should be considered as a differential diagnosis of mediastinal lymphadenopathy in intermediate tuberculosis (TB) prevalence country. The aim of this retrospective study was to investigate the clinical utility of routine acid-fast bacillus (AFB) culture and MTB PCR (Mycobacterium tuberculosis polymerase chain reaction) during endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) in intermediate tuberculosis prevalence country. Methods: In our institution, we performed routine AFB stain/culture and MTB PCR using the aspirate of lymph node which was obtained from EBUS-TBNA. From May 2009 to December 2013, the patients who underwent EBUS-TBNA for the diagnosis and nodal staging of lung cancer extrapulmonary malignancy were included. We excluded the patients who were suspected of sarcoidosis or tuberculous lymphadenitis. The findings of AFB stain/culture, MTB PCR and biopsy were reviewed. Results: During the study period, a total of 1528 patients were included in the study. The median age of study patients was 66 years (range 19-90). Male was 73.5% (1123 /1528). The indications of EBUS-TBNA were as follows; 1340 (87.7%) for the initial diagnosis, staging, or confirmation of relapse of lung cancer, 188 (12.3%) for nodal staging or confirmation of relapse of extrapulmonary malignancy. Tuberculous lymphadenitis was diagnosed in 34 (2.2%) of 1528 patients. In subgroup analysis, tuberculous lymphadenitis was diagnosed in 19 (1.4%) of 1340 patients with lung cancer and in 15 (8.0%) of 188 patients with extrapulmonary malignancy, respectively. Conclusions: Concomitant tuberculous lymphadenitis was diagnosed in 2.2% of patients who had confirmed or suspicious primary lung cancer or extrapulmonary malignancy. Therefore, routine AFB culture and MTB PCR should be considered during EBUS-TBNA in the intermediate tuberculosis prevalence country.