Utility of EBUS-TBNA in diagnosing mediastinal tuberculous lymphadenitis in East London

•EBUS-TBNA is a useful tool in the diagnosis of intrathoracic tuberculous lymphadenopathy and other pathologies.•In higher tuberculosis incidence areas, EBUS-TBNA samples from all cases of undiagnosed lymphadenopathy should undergo mycobacterial culture.•Clinical suspicion of tuberculosis does not always correlate with a confirmed diagnosis of tuberculosis.•Obtaining culture confirmation remains important in an era of significant drug-resistance. To characterise and describe the diagnostic utility of Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in intrathoracic tuberculosis in a cohort of patients with mediastinal lymphadenopathy of unknown aetiology. Consecutive patients with intrathoracic lymphadenopathy undergoing EBUS-TBNA between 2012 and 2016 were identified. Demographic data, biopsy cytopathology and mycobacteriology results, HIV and vitamin D status, susceptibility results and final diagnoses were recorded. Pre- and post-procedure probability scores were assigned to each case to reflect the probability of tuberculosis. 315 cases were identified; 54 (17.1%) had tuberculosis and 261 (82.9%) had a non-tuberculosis diagnosis. amongst TB cases, the sensitivity of EBUS-TBNA was 59.3% (95% CI 45.06–72.14), specificity 100% (95% CI 98.19–100) and the negative predictive value (NPV) was 92.23% (95% CI 88.31–94.95). 19/54 (35%) TB cases were confirmed by EBUS mycobacterial culture and 13/54 (24.1%) by cytopathology. 33 (61.1%) of the TB cases, had a low to medium pre-test probability score assigned prior to EBUS-TBNA. Amongst EBUS culture-confirmed cases, we found a resistance rate of 10.5% to one or more first line TB drugs, with one case of multi-drug resistant TB. We confirmed the utility of EBUS-TBNA in the diagnosis of intrathoracic tuberculosis in an undifferentiated cohort of patients with mediastinal lymphadenopathy of unknown aetiology and advocate sending samples for mycobacterial culture in all cases in high tuberculosis incidence areas.