Anatomical and histopathological airway abnormalities detected during fiberoptic bronchoscopy in patients with mediastinal lymphadenopathy

BackgroundThe diagnosis in cases of mediastinal and hilar lymphadenitis without parenchymal involvement of the lung is often difficult. Mediastinal lymphadenopathy may be due to a variety of benign or malignant reasons. Hence, it is important to establish a diagnosis and differentiate benign from malignant lymph nodes.Aim of the workTo study the usefulness of fiberoptic bronchoscopy in diagnosis of patients with mediastinal lymphadenopathy.Patients and methodsThe present study included 30 patients with mediastinal lymphadenopathy. All were subjected to written informed consent, full history taking, full clinical examination, tuberculin skin test, chest X-ray and CT chest. Fiberoptic bronchoscopy including autofluorescence bronchoscopy with mucosal biopsies, TBNA and bronchial lavage were also obtained.Results46.7% of the study patients were diagnosed as malignancy, 20% diagnosed as sarcoidosis, 10% diagnosed as TB, 3.33% diagnosed as reactive lymphadenitis and 20% were undiagnosed. Observed anatomical airway abnormalities included vocal cord paralysis (16.7%), tracheal compression (3.3%), widening of main or second carina (80%) and mucosal abnormalities (46.7%) in the form of nodules, infiltration with tumour tissue and unhealthy mucosa. Bronchial mucosal biopsy was the most useful method of diagnosis (56.7%) followed by TBNA (30%) and finally BAL (13.3%). AFB has no cost effective value over WLB in detection of malignant lesions.ConclusionThe best diagnostic yield was obtained by combination of bronchial mucosal biopsy and TBNA techniques.