Madhusudan Manoj, Potti Priyanka, Mohite Kaustubh, Chandra Tejaswi, Srikanta J T
Department of Pediatric Interventional Pulmonology and Sleep Medicine, Aster CMI Hospital, Bengaluru, Karnataka, India.
Department of Pediatric Pulmonology, Sai Child Care Hospital, Panvel, Mumbai, Maharashtra, India.
Lung India. 2025 May 1;42(3):199-203. doi: 10.4103/lungindia.lungindia_288_24. Epub 2025 Apr 29.
Mediastinal Tuberculosis (TB), although a common presentation of TB in children, has a very low rate of microbiological confirmation. This is because of the difficulty in acquiring appropriate tissue samples for microbiological confirmation. Endobronchial ultrasound (EBUS) and esophageal ultrasound with a bronchoscope (EUS-B) offer a safe, effective, and minimally invasive modality of sampling in these children. We present our institutional experience on EBUS/EUSB and the various ancillary investigations for mediastinal TB.
This is a single-center retrospective study among children who underwent EBUS/EUS-B for a mediastinal nodal lesion. The primary objective of the study was to analyze the diagnostic accuracy of histopathology and various microbiological investigations, through EBUS/EUS-B guided TBNA, in the diagnosis of mediastinal TB. The secondary objective was to ascertain the safety of EBUS/EUS-B.
A total of 50 children underwent EBUS/EUS-B at our center, of those 26 (17 girls, mean age 11.7 years) were diagnosed with mediastinal TB. Fever was the most common presenting symptom (85%) and only seven children (26%) had a concomitant pulmonary involvement. The diagnostic performance of various investigations was as follows: Acid-fast bacilli (AFB) smear (sensitivity - 86.6%, specificity - 82.9%, NPV-93.5%, PPV - 68.4%), Xpert Ultra (sensitivity -100%, specificity - 68.5%, NPV - 100%, PPV - 57.7%), and cytology (sensitivity - 100%, specificity - 82.9%, NPV - 100%, PPV - 71.4%). A microbiological confirmation was attained in 81% of the children. There were no major complications in any of the procedures.
EBUS/EUSB is an effective and safe investigation for the diagnosis of mediastinal TB in children.
纵隔结核虽然是儿童结核病的常见表现，但微生物学确诊率很低。这是因为获取合适的组织样本进行微生物学确诊存在困难。支气管内超声（EBUS）和带支气管镜的食管超声（EUS-B）为这些儿童提供了一种安全、有效且微创的采样方式。我们介绍我们机构在EBUS/EUSB以及纵隔结核的各种辅助检查方面的经验。
这是一项针对因纵隔淋巴结病变接受EBUS/EUS-B检查的儿童的单中心回顾性研究。该研究的主要目的是通过EBUS/EUS-B引导下的经支气管针吸活检（TBNA）分析组织病理学和各种微生物学检查在纵隔结核诊断中的诊断准确性。次要目的是确定EBUS/EUS-B的安全性。
我们中心共有50名儿童接受了EBUS/EUS-B检查，其中26名（17名女孩，平均年龄11.7岁）被诊断为纵隔结核。发热是最常见的症状（85%），只有7名儿童（26%）伴有肺部受累。各种检查的诊断性能如下：抗酸杆菌（AFB）涂片（敏感性 - 86.6%，特异性 - 82.9%，阴性预测值 - 93.5%，阳性预测值 - 68.4%），Xpert Ultra（敏感性 - 100%，特异性 - 68.5%，阴性预测值 - 100%，阳性预测值 - 57.7%），以及细胞学检查（敏感性 - 100%，特异性 - 82.9%，阴性预测值 - 100%，阳性预测值 - 71.4%）。81%的儿童获得了微生物学确诊。所有操作均未出现重大并发症。
EBUS/EUSB是诊断儿童纵隔结核的一种有效且安全的检查方法。
