One-year clinical follow-up of granulomatous lymphadenitis diagnosed via EBUS-TBNA in a tuberculosis-endemic region.

BACKGROUND/AIM: Granulomatous lymphadenitis is not a specific clinical diagnosis. In regions where tuberculosis (TB) is endemic, differentiating between various diseases presenting with granulomatous lymphadenitis poses a significant clinical challenge. This study aims to evaluate the etiological distribution of underlying conditions and to assess diagnosis changes observed during at least one year of follow-up in patients diagnosed with granulomatous lymphadenitis through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

MATERIALS AND METHODS

A total of 4711 patients were included in the study, and 9353 lymph node samples were collected. Granulomatous lymphadenitis was identified in 791 patients, from whom 1505 lymph node samples were obtained. A cohort of 453 patients was monitored for at least 1 year, during which 873 lymph node samples were collected. The medical records of these patients were retrospectively reviewed in detail, and the final clinical diagnosis for each patient was established at the conclusion of the 1-year follow-up period.

RESULTS

Sarcoidosis was the most common final diagnosis, accounting for 52.3% of cases, while tuberculosis lymphadenitis was diagnosed in 42.6% of patients. Diagnostic procedures, including acid-fast bacteria (AFB) staining, culture, and TB-PCR, were performed in 94.3% of the cohort. Nonnecrotizing granulomatous lymphadenitis was identified in 8 patients with a history of extrathoracic malignancy; 5 were diagnosed with sarcoid-like reactions and 3 with TB lymphadenitis. Additionally, during the 1-year clinical follow-up period, the initial diagnosis was revised in 14 patients.

CONCLUSION

Long-term follow-up of clinical progression and treatment response is crucial for precise diagnosis and management. The study findings suggest that routine TB-PCR and AFB testing on EBUS-TBNA-derived lymph node samples could enhance diagnostic precision.