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.

Background: Endobronchial 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.

Objective: To describe the utility and safety of EBUS-TBNA and EUS-B-FNA in children with mediastinal pathologies of unknown etiology.

Design: Chart review.

Setting: Pediatric Chest and Tuberculosis Clinics, Department of Pediatrics, AIIMS, New Delhi from May 2015 to March 2018.

Patients: Children <18 years of age with mediastinal pathologies of undefined etiology.

Methods: Case 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.

Results: Thirty 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.

Conclusion: EBUS-TBNA and EUS-B-FNA are helpful in children with undiagnosed mediastinal pathology with fair diagnostic yield and excellent patient safety profile.