DOI: 10.4103/jopp.jopp_34_25 ISSN: 2949-8074

Comparison of Diagnostic Yield of Endobronchial Ultrasound-guided Biopsy and Bronchoalveolar Lavage in Pediatric Thoracic Tuberculosis: A Multicenter Prospective Study

Kaustubh Mohite, Parmanand Andankar, Sudhir Sane, Dilip Chavan, Mahesh Mohite
Show PDF Cite

Abstract

Background/Objectives:

The paucibacillary nature of pediatric pulmonary tuberculosis (TB) makes microbiological confirmation challenging. Bronchoalveolar lavage (BAL), though commonly used, often yields low sensitivity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard diagnostic tool in adults for mediastinal lymph nodes, but its comparative efficacy in children remains underexplored. This study evaluated and compared the diagnostic performance of BAL and EBUS-TBNA/core biopsy in children with suspected thoracic TB exhibiting mediastinal lymphadenopathy on imaging.

Materials and Methods:

From January 2023 to December 2024, 52 children under 18 years with computed tomography (CT) evidence of parenchymal lung involvement and mediastinal lymphadenopathy were enrolled across three centers in Mumbai, India. All participants underwent both flexible bronchoscopy with BAL and EBUS-TBNA under general anesthesia. Samples were analyzed for acid-fast bacilli (AFB) stain, mycobacterial culture, GeneXpert Mycobacterium tuberculosis /rifampicin resistance assay, and histopathology (EBUS cores).

Results:

The mean age of participants was 7.2 years (range: 1.5–16 years). The right lower lobe (42.3%) and subcarinal lymph nodes (76.9%) were the most frequently involved sites. EBUS-TBNA significantly outperformed BAL across all microbiological parameters: AFB culture (84.6% vs. 65.4%; absolute difference: +19.2%; P = 0.012), GeneXpert (76.9% vs. 53.8%; absolute difference: +23.1%; P = 0.003), and AFB smear (61.5% vs. 46.1%; absolute difference: +15.4%; P = 0.039). Histopathological examination of EBUS core biopsies confirmed diagnosis in an additional four culture-negative cases, elevating the overall diagnostic yield of the EBUS platform to 92.3% compared with 65.4% for BAL (absolute difference: +26.9%). Both procedures were well-tolerated with no major complications.

Conclusion:

EBUS-TBNA is a safe and better diagnostic modality than BAL for confirming thoracic TB in children, particularly in the presence of CT evidence of mediastinal lymphadenopathy. The higher bacillary load in mediastinal lymph nodes makes them a superior target for sampling. In highly specialized centers with trained persons, EBUS should be considered as the first-line invasive diagnostic test for children with radiologically evident mediastinal lymphadenopathy.

More from our Archive