Diagnosis of mediastinal tuberculosis by using EUS-guided needle sampling in a geographic region with an intermediate tuberculosis burden

Gastrointest Endosc. 2010 Jun;71(7):1307-13. doi: 10.1016/j.gie.2010.01.059. Epub 2010 Apr 24.


Background: EUS-guided FNA (EUS-FNA) or trucut biopsy (TCB) is indispensible in the diagnosis of mediastinal malignancies. Less is known, however, about the usefulness of EUS-guided sampling for nonmalignant, mediastinal tuberculosis (TB), despite the increase in the incidence of TB.

Objective: To assess the diagnostic yields of EUS-FNA/TCB in patients with mediastinal TB.

Design: Retrospective study.

Setting: Tertiary-care referral hospital in a geographic region with an intermediate TB burden.

Patients: This study involved 24 consecutive patients with mediastinal TB, who underwent EUS-FNA/TCB from July 2005 to September 2008.

Intervention: EUS-FNA/TCB.

Main outcome measurements: Technical success and diagnostic yields of EUS-FNA/TCB.

Results: Mediastinal lesions (mean diameter, 28.6 mm; range 17.0-49.5 mm) were targeted by using 22-gauge-needle FNA in 10 patients and 19-gauge-needle TCB in 14 patients. Before EUS, only 10 of the 24 patients had a presumptive diagnosis of mediastinal TB, whereas 11 patients were suspected of having malignancies. Six patients showed mass-like lung parenchymal lesions mimicking lung cancer, and 7 patients had a history of malignancy. Pathologic examination showed granulomatous inflammation in 16 patients (66.7%), including 10 patients with caseating granulomas. Positive microbiologic results were obtained in 10 patients (41.7%): 3 by Ziehl-Neelsen staining, 5 by Mycobacterium tuberculosis culture, and 5 by TB polymerase chain reaction (PCR) assay. EUS-FNA/TCB confirmed mediastinal TB in 20 of the 24 patients and directed 11 patients clinically suspected of having malignancies to anti-TB treatment. The diagnostic yields of FNA and TCB were similar (90.0% vs 78.6%).

Limitations: Retrospective design in a tertiary-care referral hospital.

Conclusion: EUS-FNA/TCB is sufficiently useful to confirm mediastinal TB and can exclude suspected malignancies in TB patients.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy, Fine-Needle / instrumentation*
  • DNA, Bacterial / analysis
  • Diagnosis, Differential
  • Endemic Diseases
  • Endosonography / methods*
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Humans
  • Korea / epidemiology
  • Male
  • Mediastinitis / diagnosis*
  • Mediastinitis / epidemiology
  • Mediastinitis / microbiology
  • Mediastinum / diagnostic imaging
  • Mediastinum / microbiology
  • Mediastinum / pathology*
  • Middle Aged
  • Mycobacterium tuberculosis / genetics
  • Mycobacterium tuberculosis / isolation & purification
  • Polymerase Chain Reaction
  • Prevalence
  • Retrospective Studies
  • Tuberculosis / diagnosis*
  • Tuberculosis / epidemiology
  • Tuberculosis / microbiology
  • Young Adult


  • DNA, Bacterial