Endobronchial Ultrasound With Transbronchial Needle Aspiration in the Diagnosis of Bilateral Hilar and Mediastinal Lymphadenopathy

Background: Bilateral hilar and/or mediastinal lymphadenopathy (BHL +/- ML) is an important radiographic finding. Since it was examined 38 years ago by Winterbauer and colleagues, better diagnostic techniques have been developed. The purpose of this study was to reexamine the diagnosis of BHL +/- ML by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA). Methods: We carried out a retrospective analysis of data from 78 consecutive patients with BHL +/- ML who underwent EBUS-TBNA. Patient's characteristics including age, sex, symptoms, radiographic abnormalities, lymph node size, procedural complications, and the final pathologic diagnosis were recorded. Results: There were 8 diagnostic categories. Sarcoidosis was the most common diagnosis (73%), followed by lymphoma (10%), and reactive lymphadenopathy (10%). Nonlymphoma malignancy was found in 1 case. Seventy-three percent of the patients with sarcoidosis had stage 1 and 27% had stage 2 disease. The diagnosis was made by EBUS-TBNA in 92.3% of the cases. The diagnostic accuracy for EBUS-TBNA was 95% for stage 1 and 93% for stage 2. Fifty one percent of the patients were asymptomatic. Fifty seven percent of sarcoidosis and 36% of the nonsarcoidosis patients were asymptomatic. There were no significant complications from EBUS-TBNA. Conclusions: EBUS-TBNA is a safe and minimally invasive procedure with a high diagnostic yield for BHL +/- ML. Sarcoidosis is still the most common diagnosis but the incidence seems to have decreased over the years. The increase in nonsarcoidosis patients and the evidence that lymphoma does occur in some asymptomatic patients suggests that biopsy confirmation with EBUS-TBNA is warranted.