CT-GUIDED FINE-NEEDLE ASPIRATION BIOPSY IN THE DIAGNOSIS OF MEDIASTINAL TUBERCULOSIS

Twenty-two patients with mediastinal tuberculosis were reviewed. The m ost common symptoms were chest pain, cough, fever, and weight loss. Re sults of the physical examination were unremarkable. The chest radiogr aphs of all 22 patients showed abnormal mediastinum with no evidence o f extramediastinal disease. Most (62%) had right-sided paratracheal ly mphadenopathy. Mantoux skin test was positive (>15 mm) in all patients , whereas sputum smears and cultures for acid-fast bacilli were negati ve. Computed tomographic (CT) guided fine needle aspiration biopsies ( FNAB) were performed in 12 patients using 22- to 25-gauge needles. Ten patients had fiberoptic bronchoscopic (FOB) examination with brushing s and biopsies. Mediastinoscopy (n=8) or thoracotomy (n=6) was perform ed in patients where either FNAB or FOB was not diagnostic or where ly mphoma was suspected clinically. The rates of true-positive diagnoses were 20%, 66%, 75%, and 100% for FOB, FNAB, mediastinoscopy, and thora cotomy, respectively. The rate of false-negative for FNAB was 34%. Onl y one patient developed nonsignificant pneumothorax after FNAB. These findings suggest that CT-guided FNAB is a useful and safe procedure an d should be considered in the initial evaluation of patients suspected of having mediastinal tuberculosis.