Safety and diagnostic yield of endobronchial ultrasound-guided lymph
node biopsy in children and adolescents with suspected tuberculosis
Abstract
Referring to a literature review published recently in this Journal, we
report a single-center case series of 45 children and adolescents (age
2-17 years) with suspected tuberculosis (TB) and negative microscopy on
repeated sputum or gastric aspirate samples. All subjects underwent
flexible airway endoscopy including bronchoalveolar lavage (BAL) and
endobronchial ultrasound-guided transbronchial needle aspiration
(EBUS-TBNA) without adverse events. Among 41 subjects with a final TB
diagnosis, Mycobacterium tuberculosis was detected by PCR and/or culture
in 20 (49% bacteriological confirmation) with 11 cases relying
exclusively on results from TBNA samples. Only 7 of 17 positive culture
results related to sputum (17% confirmation rate), and 9 of 17 on the
combination of sputum and BAL (22%) respectively. The sampling site of
a person’s first positive culture was TBNA in 13 of 17 cases (76%).
Bacteriological confirmation was essential for diagnostic accuracy and
tailored treatment based on individual drug susceptibility testing. We
therefore recommend the inclusion of bronchoscopy and EBUS-TBNA in a
comprehensive diagnostic protocol for smear-negative pediatric TB
suspects.