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Free Content Ultrasound guided fine needle aspiration biopsy in mediastinal tuberculosis

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SETTING: Diagnosis of mediastinal tuberculosis (TB) is difficult due to non-specific clinical features and lack of characteristic radiographic features. Histopathological confirmation has often required computed tomography guided fine needle aspiration biopsy (FNAB) or even invasive procedures such as mediastinoscopy or open/surgical biopsy. FNAB under ultrasound (US) guidance can also be performed in this clinical setting.

OBJECTIVE: To define the role of percutaneous US guided FNAB in the diagnosis of mediastinal tuberculosis.

DESIGN: Twenty-six patients with a proven diagnosis of mediastinal TB formed the study group. Chest radiographs and sputum examination were negative. FNAB was performed via suprasternal (n = 20) and parasternal (n = 6) route under sonographic guidance using 22G spinal needle. Aspirates were considered positive for TB when epithelioid cell granuloma with caseation necrosis and/or the presence of Mycobacterium tuberculosis by acid-fast bacilli (AFB) or culture was demonstrated, in-determinate when epithelioid cell granulomas were seen but without caseation necrosis or AFB, and negative when aspirate contained non-representative material.

RESULTS: A total of 30 biopsies were performed in the 26 patients, including repeat biopsy and biopsy of different sites in two patients each. FNAB was positive for TB in 20 of the 26 patients. In four, AFB were demonstrated, and in seven culture was positive for M. tuberculosis; in the remaining six patients, cytologic diagnosis was indeterminate in four and negative in two. No procedure related complications were noted.

CONCLUSION: Ultrasound guided FNAB is a safe, effective technique in the diagnosis of mediastinal TB.

Keywords: biopsy; mediastinal; tuberculosis; ultrasound guidance

Document Type: Regular Paper

Affiliations: 1: Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2: Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Publication date: December 1, 2000

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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