Diagnostic utility of flexible bronchoscopy in mediastinal and hilar lymphadenopathies

Background Mediastinal and/or hilar lymphadenopathy with or without parenchymal lesions are difficult in the diagnosis via noninvasive techniques. Objective To assess the role of flexible fiberoptic bronchoscopy (FOB), in particular, blind transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal and/or hilar lymphadenopathies. Patients and methods A cross-sectional study was carried out on 42 out of 83 patients presented by chest radiography of hilar and/or mediastinal lymphadenopathies with or without parenchymal lesions. Contrast-enhanced computed tomography chest and FOB, TBNA, and bronchoalveolar lavage were done for all patients. Forceps biopsy and bronchial brushing were done for some patients with bronchoscopic airway abnormalities. Results A total of 52 patients underwent FOB procedures; among them 10 (19.2%) patients were excluded due to nonconclusive diagnosis for further evaluations; final histopathological and/or microbiological diagnosis was confirmed in 42 (80.8%) patients, and they were included in data analysis. Among them, 25 (59.5%) patients had malignant lymphadenopathies (five patients had small cell lung cancer, 18 patients had nonsmall cell lung cancer, and two patients had lymphoma) and 17 (40.5%) had benign lymphadenopathies (eight patients had sarcoidosis, three patients had tuberculosis, six patients had reactive lymphadenitis). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TBNA in the diagnosis of intrathoracic lymphadenopathies were 75.00, 54.50, 60.00, 70.60, and 64.29%, respectively. Conclusion Bronchoscopy with TBNA has good sensitivity and negative predictive value with fair specificity and positive predictive value in the diagnosis of intrathoracic lymphadenopathies. TBNA is a safe, effective procedure and can be performed easily during routine diagnostic bronchoscopy, and minimize the requirement for mediastinoscopy and thoracotomy.