Original Research Article http://doi.org/10.18231/j.ijirm.2019.027 IP Indian Journal of Immunology and Respiratory Medicine, April-June, 2019;4(2):118-122 118 Utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) and additional value of cell block in the diagnosis of mediastinal lymphadenopathy: A one year study in a tertiary care hospital in north India Natasha Mittal 1 , Bhaskar Das 2* , Manisha Mendiratta 3 , Vidya Nair 4 , Vipin Gupta 5 1 Consultant Pathologist, 2 Consultant Microbiologist, 3,4 Consultant Pulmonologist, 5 Associate Consultant Pulmonologist, 1 Dept. of Pathology, 2 Dept. of Microbiology, 3-5 Dept. of Pulmonary Medicine, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India *Corresponding Author: Bhaskar Das Email: drbhaskarinnet@gmail.com Abstract Background: Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is a technique using which mediastinal lymph nodes can be sampled under real time ultrasonographic visualisation. In addition cell block can be prepared leading to increased diagnostic yield. We conducted a retrospective study to evaluate the role of EBUS-TBNA FNA and cell block in patients of enlarged mediastinal and hilar lymph nodes. Methodology: We retrospectively studied 100 patients who underwent EBUS-TBNA FNA along with cell block preparation between January 2018 to December 2018. Bronchoalveolar lavage was also done. AFB staining and routine and fungal culture and sensitivity were done in all patients. The diagnostic accuracy of the FNA and cell block was analysed. Results: We found 80% sensitivity and 100% specificity of EBUS-TBNA FNA. Sensitivity and specificity of cell block were found to be 94% and 100% respectively. Diagnostic accuracy of EBUS-TBNA FNA for tuberculosis and malignancy was 66.7% and 90% respectively while that of cell block was 83.3% and 90% for tuberculosis and malignancy respectively. Both FNA and cell block had 100% diagnostic accuracy for sarcoidosis. Conclusions: In patients of mediastinal and hilar lymphadenopathy, EBUS-TBNA can be used as a procedure of choice as this is a safe procedure with reasonably high diagnostic accuracy. The sensitivity increases when EBUS aspirate is used along with cell block. Additional studies like IHC can be done on the cell block in patients of malignancy. Keywords: EBUS TBNA FNA; Cell block; Mediastinal lymphadenopathy; Tuberculosis; Sarcoidosis; Malignancy. Introduction Endobronchial Ultrasound-guided Transbronchial needle aspiration (EBUS-TBNA) is a technique by which mediastinal lymph nodes can be sampled using fine needle aspiration under direct ultrasonographic visualisation. As the aspiration biopsy is being performed under real time monitoring of ultrasound image the safety and accuracy is significantly increased as compared to conventional TBNA [1]. EBUS-TBNA is a minimally invasive technique which finds its use as a diagnostic procedure for patients of tuberculosis, sarcoidosis, lymphoma and malignancy presenting with mediastinal lymphadenopathy [2]. This technique also finds its merit in lung cancer staging and as a diagnostic procedure for intrapulmonary tumors [3]. Endobronchial ultrasound (EBUS) enables the visualization of lymph node structure, thus allowing the pulmonologist to evaluate and sample lymph nodes. Tumor invasion of the tracheobronchial wall can be assessed more accurately with EBUS than with CT [4]. This procedure has been used successfully and safely for sampling mediastinal and hilar lymph nodes over the past decade. Because of ultrasound guidance even nodes <10 mm can be safely aspirated. In patients with lung cancer and sarcoidosis, EBUS-TBNA has been shown to increase the yield and sensitivity compared with standard bronchoscopic techniques including conventional TBNA [5]. Further it offers a less invasive and safer technique compared with mediastinoscopy to sample intrathoracic lymph nodes [6]. This procedure can be performed in the ambulatory care setting under sedation and tissue can be obtained with less potential complications [7]. Various studies have demonstrated a high sensitivity and specificity of EBUS-TBNA in detecting benign and malignant lung diseases [8,9]. EBUS-TBNA is an important alternative of mediastinoscopy in diagnosis of granulomatous intrathoracic lymphadenopathy with a high diagnostic accuracy in intrathoracic tubercular lymphadenopathy. As compared to conventional TBNA a higher smear and culture positivity can be obtained in a tuberculosis patient using EBUS-TBNA [10]. Even though newer modalities like Positron emission tomography-CT (PET-CT) have revolutionized cancer diagnosis, still tissue sampling would be needed to achieve the correct pathological diagnosis [11]. One additional advantage of EBUS is that cell block can be prepared which not only increases the diagnostic yield but can be utilized for additional studies like IHC [12]. There have been few studies demonstrating the efficacy of EBUS-TBNA FNA and cell block in the diagnosis of mediastinal lymphadenopathy. We present a one year retrospective study demonstrating the efficacy of EBUS-TBNA FNA and the additional utility of cell block. Materials and Methods This is a one year retrospective study from January 2018 to December 2018. An ethical committee approval and a written informed consent from study subjects was obtained. A total of hundred patients who underwent EBUS-TBNA for hilar or mediastinal lymphadenopathy at our institution