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Choe J, Han A, Shin SH, Lee K, Um SW, Kim H, Kim TY, Huh HJ, Choi YL, Han J, Jeong BH. Clinical Course of Patients With Mediastinal Lymph Node Tuberculosis and Risk Factors for Paradoxical Responses. J Korean Med Sci 2023; 38:e348. [PMID: 38050909 PMCID: PMC10695755 DOI: 10.3346/jkms.2023.38.e348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Paradoxical responses (PR) occur more frequently in lymph node tuberculosis (LNTB) than in pulmonary tuberculosis and present difficulties in differential diagnosis of drug resistance, new infection, poor patient compliance, and adverse drug reactions. Although diagnosis of mediastinal LNTB has become much easier with the development of endosonography, limited information is available. The aim of this study was to investigate the clinical course of mediastinal LNTB and the risk factors associated with PR. METHODS Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR. RESULTS Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81-18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60-46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70-16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB. CONCLUSION As PR occurred in one of six patients with mediastinal LNTB during anti-tuberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.
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Affiliation(s)
- Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Areum Han
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yeul Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Tang CL, Zhu Z, Zhong CH, Zhou ZQ, Zhou HQ, Geng RM, Chen XB, Chen Y, Li SY. Clinical application of endobronchial ultrasonography-guided transbronchial needle aspiration biopsy-a single center, large sample, real-world study. BMC Pulm Med 2023; 23:336. [PMID: 37689634 PMCID: PMC10492366 DOI: 10.1186/s12890-023-02568-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy (EBUS-TBNA) has been used for more than 10 years in China. Its clinical application and diagnostic value in different diseases with large sample was lack of report. METHODS A retrospective analysis was performed about the application and diagnostic value of EBUS-TBNA in different disease of patients in Respiratory Intervention Center of Guangzhou Institute of Respiratory Health from January 2012 to July 2020. RESULTS A total 5758 patients were included with 182 patients excluded for lack of information. Finally, data of 5576 patients (3798 males and 1778 females) were analyzed. For anesthetize, most patients were undergoing general anesthesia of intravenous with spontaneous breathing (69.4%), followed by general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation (17.9%) and conscious sedation and analgesia (12.8%). Lymph nodes were the main sites of biopsy obtained (76.4%). Tumors accounted for the highest proportion of disease (66.4%), followed by infection diseases (9.9%), sarcoidosis (3.9%), lymphoma (1.1%), and others (18.7%). The sensitivity of EBUS-TBNA for diagnosis of tumor was 89.7%, and 40.8% for infection diseases. There were significant differences in the puncture site and proportions of diseases between male and females (both p < 0.05). Higher diagnostic value was found in male patients (p < 0.05). CONCLUSION EBUS-TBNA has good diagnostic value for different mediastinal and central pulmonary space-occupying lesions diseases, with highest sensitivity for tumors. Higher diagnostic value was found in male patients.
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Affiliation(s)
- Chun-Li Tang
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zheng Zhu
- Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, Guangzhou, China
| | - Chang-Hao Zhong
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zi-Qing Zhou
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Hui-Qi Zhou
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Rong-Mei Geng
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xiao-Bo Chen
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Shi-Yue Li
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China.
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