Utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration in children with mediastinal pathology

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration (EUS-B-FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children. ObjectiveTo describe the utility and safety of EBUS-TBNA and EUS-B-FNA in children with mediastinal pathologies of unknown etiology. DesignChart review. SettingPediatric Chest and Tuberculosis Clinics, Department of Pediatrics, AIIMS, New Delhi from May 2015 to March 2018. PatientsChildren <18 years of age with mediastinal pathologies of undefined etiology. MethodsCase records of children who underwent EBUS-TBNA and EUS-B-FNA were reviewed. Data on demographic profile, clinical features, laboratory investigations, the technique of EBUS-TBNA/ EUS -B- FNA, complications, and findings were collected. ResultsThirty children (19 males) with mean (SD) age of 9.6 (3.5) years underwent endobronchial procedures. Median (IQR) weight(kg) and height(cm) were 29(19.5,35) and 134(125,150) respectively. Tuberculosis was the most common preprocedure clinical diagnosis(73.3%), followed by lymphoma(13.3%). Presenting features were fever (80%), cough (53.3%), hepatomegaly (13%), peripheral lymphadenopathy (21.7%), and positive tuberculin skin test (63.3%). Approximately one fourth were on antitubercular therapy without definite evidence of TB. Conscious sedation was used for the procedures: midazolam and fentanyl (n=22), propofol(n=8). Transesophageal, transtracheal, and both routes were used in 20(66.6%), 7(23.3%), and 3(10.1%), respectively. Lymph-nodes were sampled in 24 children (subcarinal in 16, right paratracheal in 4 and both in 4). Mean (SD) size of lymph node (in cm) on EBUS was 1.93(+/- 0.5) and median (IQR) number of FNAC needle passes per node were 2(2,4). The diagnosis was confirmed in 11 (36.6%, tuberculosis in 10 by GeneXpert/MGIT/cytopath and lymphoma in one) patients. Only 3.3% had a minor complication. ConclusionEBUS-TBNA and EUS-B-FNA are helpful in children with undiagnosed mediastinal pathology with fair diagnostic yield and excellent patient safety profile.