Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) using 19G needle tract: First case series from India.

EBUS-TBNA is a well-established procedure for diagnosis of mediastinal lymphadenopathy replacing the need for mediastinoscopy. In certain diseases like lymphomas, the yield is reportedly 50%, sarcoidosis lymph nodes also give a yield of 80% with EBUS and at times, more material is needed for better characterization of malignancies. EBUS-intranodal forceps biopsy may be useful in these situations. In our series of seven cases, we describe a unique and safe technique of obtaining forceps biopsy from mediastinal lymph nodes under real-time endobronchial ultrasound guidance using a 19G EBUS-TBNA needle tract and thin biopsy forceps. Lymph node biopsy was able to give a conclusive diagnosis in 42% patients negative with TBNA, and was able to suggest a diagnosis in one case. No complications were seen. Thus, surgical biopsy can be avoided in nearly 50% of failed EBUS-FNAC cases.

Multidrug resistance in tubercular mediastinal adenopathy diagnosed by endobronchial ultrasound-transbronchial needle aspiration.

BACKGROUND: Drug resistance in tuberculosis (TB) is a major public health problem. It is easy to assess for drug resistance in pulmonary samples, but the resistance pattern of TB in the mediastinal nodes has not been studied. The aim of this study is to assess the incidence of multidrug resistance in tubercular mediastinal adenopathy with the help of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration. MATERIALS AND METHODS: This was a prospective study at a tertiary care teaching hospital in New Delhi where 102 patients with positive mycobacterial cultures from mediastinal lymph node aspirates taken with the help of EBUS were enrolled over 24 months and their drug sensitivity to the first-line antitubercular drugs analyzed. RESULTS: There were 30 cases of drug resistance of 102 culture-positive cases. Of them, 8 patients had multidrug resistant TB (MDR-TB), 16 cases had only single drug resistance, and the remaining 6 cases had more than one drug resistance pattern but not MDR. In our study, the overall incidence of MDR-TB is 7.8% (8/102), although the incidence of MDR-TB in new and re-treatment cases is 2.2% (2/89) and 46.1% (6/13), respectively. CONCLUSION: Such a high percentage of drug-resistant patients is common in tertiary care hospitals; however, similar percentages may be found in other settings as well. Therefore, all efforts should be made to take samples for Mycobacterium tuberculosis culture from the involved nodes before commencing therapy to avoid treatment failures.