Diagnostic value of EBUS-TBNA for intrathoracic tuberculous lymphadenitis: a retrospective cohort analysis stratified by anti-tuberculosis treatment duration.

BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely adopted to diagnose intrathoracic lymphadenopathy, including tuberculous lymphadenitis (TBLA). However, the influence of anti-tuberculosis (anti-TB) treatment duration on its diagnostic yield remains unclear.

METHODS

In this retrospective cohort study, 78patients with suspected intrathoracic TBLA who underwent EBUS-TBNA between June 2017 and January 2024 were included. Patients were categorized into four groups by prior anti-TB treatment duration. Composite diagnostic criteria incorporating histopathology, microbiology, and treatment response were used as the reference standard. Diagnostic performance across lymph node stations and modalities was analyzed. Safety outcomes were also evaluated.

RESULTS

The overall diagnostic sensitivity of EBUS-TBNA based on composite criteria was 96.2%. Stratified analysis showed no statistically significant difference in diagnostic positivity among untreated (95.9%), 1-30 days (83.3%), 31-180 days (100%), and > 180 days (100%) groups (P = 0.42). Diagnostic yield was consistent across mediastinal, hilar, and combined lymph node stations (P = 0.289). Among diagnostic modalities, TB-DNA, histopathology TB-SPOT and sputum Xpert demonstrated high positivity rates. No major complications occurred; minor self-limited bleeding was observed in 15.4% of patients.

CONCLUSION

EBUS-TBNA is a safe and effective diagnostic tool for intrathoracic TBLA, with consistent performance in both treatment-naïve and pretreated patients, regardless of anti-TB therapy duration.