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Tetart M, Betraoui F, Huleux T, Wallyn F, Brichet A, Thill P, Robineau O, Meybeck A. Accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in HIV-infected patients with thoracic lymphadenopathy in a tuberculosis low-burden area. Sci Rep 2020; 10:16250. [PMID: 33004876 PMCID: PMC7530660 DOI: 10.1038/s41598-020-73153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/15/2020] [Indexed: 12/02/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an innovative technique to explore hilar and mediastinal lymphadenopathy. We aimed to assess its diagnostic accuracy in HIV-infected patients in a tuberculosis low-burden area. A retrospective review was performed of all HIV-infected patients with thoracic lymphadenopathy referred for EBUS-TBNA between January 2012 and January 2019 in 3 Northern French Hospitals. A total of 15 patients was included during the study period. Our patients were predominantly male (80%), with a mean age of 50 ± 11 years. Six patients (43%) had a CD4 cells count of less than 200/mm3. Eleven patients (73%) were receiving antiretroviral therapy, and 7 (47%) reached undetectable viral load. Adequate lymphnode sampling was accomplished in all patients. No serious complications were reported. EBUS-TBNA led to a definitive diagnosis in 12 out of 15 patients (80%). It identified 4 neoplasia, 3 atypical mycobacterial diseases, 2 tuberculosis, 1 Castleman disease, 1 sarcoidosis, and 1 professional dustiness. In 3 cases, sampling revealed normal lymphoid tissue. Active surveillance confirmed the suspected diagnosis of HIV adenitis with regression of lymphadenopathy on antiretroviral therapy in 2 cases. In one case of negative sampling, thoracoscopy led to the diagnosis of tuberculosis. In our cohort, accuracy of EBUS-TBNA was 92%. EBUS-TBNA appeared to be a safe and accurate tool in the investigation of mediastinal lymphadenopathy in HIV-infected patients in settings of tuberculosis low-prevalence. It can avoid more invasive procedures such as mediastinoscopy.
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Affiliation(s)
- Macha Tetart
- Service Des Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Avenue du Président Coty, 59200, Tourcoing, France
| | - Farid Betraoui
- Service de Pneumologie, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Thomas Huleux
- Service Des Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Avenue du Président Coty, 59200, Tourcoing, France
| | - Frédéric Wallyn
- Service D'Endoscopie Bronchique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Anne Brichet
- Service de Pneumologie, Centre Hospitalier de Roubaix, Roubaix, France
| | - Pauline Thill
- Service Des Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Avenue du Président Coty, 59200, Tourcoing, France
| | - Olivier Robineau
- Service Des Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Avenue du Président Coty, 59200, Tourcoing, France
| | - Agnès Meybeck
- Service Des Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Avenue du Président Coty, 59200, Tourcoing, France.
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Mehrian P, Doroudinia A, Shams M, Alizadeh N. Distribution and Characteristics of Intrathoracic Lymphadenopathy in TB/HIV Co-Infection. Infect Disord Drug Targets 2020; 19:414-420. [PMID: 30324894 DOI: 10.2174/1871526518666181016111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/22/2018] [Accepted: 10/06/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intrathoracic Lymphadenopathy (ITLN) in Human Immunodeficiency Virus (HIV) infected patients may have various etiologies and prognoses. Etiologies of ITLN can be distinguished based on the distribution of enlarged lymph nodes. Sometimes tuberculosis (TB) is the first sign of underlying HIV infection. OBJECTIVES We sought to determine ITLN distribution and associated pulmonary findings in TB/HIV co-infection using Computed Tomography (CT) scan. METHODS In this retrospective, observational, cross-sectional study, chest CT scans of 52 patients with TB/HIV co-infection were assessed for enlarged intrathoracic lymph nodes (>10 mm in short axis diameter), lymphadenopathy (LAP) distribution, calcification, conglomeration, the presence of hypodense center and associated pulmonary abnormalities. LAP distribution was compared in TB/HIV co-infection with isolated TB infection. RESULTS Mediastinal and/or hilar LAP were seen in 53.8% of TB/HIV co-infection patients. In all cases, LAP was multistational. The most frequent stations were right lower paratracheal and subcarinal stations. Lymph node conglomeration, hypodense center and calcification were noted in 25%, 21.4% and 3.5% of patients, respectively. LAP distribution was the same as that in patients with isolated TB infection except for the right hilar, right upper paratracheal and prevascular stations. All patients with mediastinal and/or hilar adenopathy had associated pulmonary abnormalities. CONCLUSION All patients with TB/HIV co-infection and mediastinal and/or hilar adenopathy had associated pulmonary abnormalities. Superior mediastinal lymph nodes were less commonly affected in TB/HIV co-infection than isolated TB.
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Affiliation(s)
- Payam Mehrian
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abtin Doroudinia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moghadaseh Shams
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Alizadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Agrawal N, Vaidya PJ, Chhajed PN. Endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) in HIV affected individuals: Is the (E)BUS ready for unchartered territories? Lung India 2018; 35:371-372. [PMID: 30168453 PMCID: PMC6120313 DOI: 10.4103/lungindia.lungindia_312_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Neha Agrawal
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India; Department of Internal Medicine, Kantonsspital Baselland, Liestal and University of Basel, Basel, Switzerland
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Jain L, Mackenzie S, Bomanji JB, Shortman R, Noursadeghi M, Edwards SG, Miller RF. 18F-Fluorodeoxyglucose positron emission tomography-computed tomography imaging in HIV-infected patients with lymphadenopathy, with or without fever and/or splenomegaly. Int J STD AIDS 2017; 29:691-694. [PMID: 29198183 DOI: 10.1177/0956462417745960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We audited whether 18F-Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) imaging could discriminate between different diagnoses in HIV-infected patients presenting with lymphadenopathy, with or without fever and/or splenomegaly. Maximum standardised uptake (SUVmax) values were similar in lymphoma and mycobacterial and fungal infections and were lower but similar in those with human herpesvirus (HHV) 8-associated disease and HIV-associated reactive lymphadenopathy. Nodal 18FDG avidity, with SUVmax ≥10, excluded diagnoses of HHV 8-associated disease and miscellaneous conditions, and HIV-associated reactive lymphadenopathy was additionally excluded in those who had undetectable plasma HIV viral loads. This audit suggests 18FDG PET-CT imaging did not permit discrimination between specific diagnoses but has utility in identifying lymph nodes with increased avidity that could be targeted for biopsy and in ruling out significant pathology.
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Affiliation(s)
- L Jain
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Mackenzie
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK
| | - J B Bomanji
- 3 Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, London, UK
| | - R Shortman
- 3 Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Noursadeghi
- 2 T8, University College London Hospitals NHS Foundation Trust, London, UK.,4 Division of Infection and Immunity, University College London, London, UK
| | - S G Edwards
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK
| | - R F Miller
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK.,5 Research Department of Infection and Population Health, Institute for Global Health, University College London, London, UK.,6 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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5
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Cheng Z, Shan F, Liu J, Shi Y, Zhang Z, Wu G. Clinical and computed tomography findings in Chinese lung cancer patients with HIV infection: A multi-center study. Thorac Cancer 2017; 8:238-245. [PMID: 28294549 PMCID: PMC5415480 DOI: 10.1111/1759-7714.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The study was conducted to investigate clinical and computed tomography (CT) features in Chinese lung cancer patients with human immunodeficiency virus (HIV). METHODS Forty consecutive lung cancer patients with HIV were included. Clinical data were collected, and CT features were reviewed and measured. The factors associated with stages of cancer and the CT features with opportunistic pulmonary infections (OPIs) were also analyzed. RESULTS Thirty-four of the patients were men (85%), and the mean age was 57.5 years. The mean CD4 count was 288 cells/μL, and 23 patients received highly active antiretroviral therapy. OPIs were common (50%). The major histological type (85%) was non-small cell lung cancer (NSCLC), and 15 NSCLC patients (44%) were in stages IIIb and IV. NSCLC patients with an OPI were more common in the advanced stages compared with those without an OPI (P = 0.04). There were no significant differences in advanced and non-advanced stages in terms of CD4 level, highly active antiretroviral therapy, and smoking (P = 0.31, P = 1.00; P = 0.49, respectively). The average size of tumors was 4.5 cm. Irregularly shaped or larger sized tumors were associated with OPIs (P = 0.03, P = 0.04, respectively). CONCLUSIONS The persistence of locally irregular and large lesions in middle-aged men with HIV and a history of OPIs should be an alert for lung cancer, and clinical management is needed.
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Affiliation(s)
- Zenghui Cheng
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Department of Radiology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jinxin Liu
- Department of Radiology, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Headmaster's Office, Fudan University, Shanghai, China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guowei Wu
- Department of Radiology, Guangxi Longtan Hospital, Liuzhou, China
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Stern JB, Wyplosz B, Girard P, Validire P, Escaut L, Caliandro R. [Endobronchial ultrasonography (EBUS) for the internist]. Rev Med Interne 2016; 37:759-765. [PMID: 27363931 DOI: 10.1016/j.revmed.2016.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/28/2016] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasonography (EBUS) is a recent mini-invasive technique allowing transbronchial needle aspiration (TBNA) of mediastinal lymph nodes as well as peribronchial lesions. EBUS was initially developed for lung cancer mediastinal staging. Over the years, indications for EBUS have been progressively extended to the scope of inflammatory disorders, mediastinal lymphomas, and infectious diseases. Particularly in immunosuppressed patients, including HIV-infected patients, EBUS allows the diagnosis of several diseases that involve the mediastinum, avoiding invasive surgical explorations such as mediastinoscopy or thoracoscopy. This review aims at discussing the technical aspects, and specifies indications, results, and limits of EBUS for the internist.
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Affiliation(s)
- J-B Stern
- Unité de pneumologie, département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Service de maladies infectieuses et tropicales, Assistance publique-Hôpitaux de Paris, CHU Bicêtre, Le Kremlin-Bicêtre, France.
| | - B Wyplosz
- Service de maladies infectieuses et tropicales, Assistance publique-Hôpitaux de Paris, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - P Girard
- Unité de pneumologie, département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - P Validire
- Département d'anatomie pathologique, institut mutualiste Montsouris, Paris, France
| | - L Escaut
- Service de maladies infectieuses et tropicales, Assistance publique-Hôpitaux de Paris, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - R Caliandro
- Unité de pneumologie, département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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Takahashi K, Porcel JM, Lee P, Leung CC. Year in review 2014: Lung cancer, pleural diseases, respiratory infections and tuberculosis, bronchoscopic intervention and imaging. Respirology 2015; 20:674-83. [DOI: 10.1111/resp.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Kazuhisa Takahashi
- Department of Respiratory Medicine; Graduate School of Medicine; Juntendo University; Tokyo Japan
| | - José M Porcel
- Pleural Medicine Unit; Department of Internal Medicine; Biomedical Research Institute of Lleida; Arnau de Vilanova University Hospital; Lleida Spain
| | - Pyng Lee
- Department of Medicine; National University Hospital; Singapore
| | - Chi Chiu Leung
- Tuberculosis and Chest Service; Department of Health; Hong Kong China
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8
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Gingo MR. The changing landscape of HIV-related lung disease: non-AIDS lung malignancy as a player in the field. Respirology 2015; 19:300-2. [PMID: 24620759 DOI: 10.1111/resp.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Matthew R Gingo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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