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

Background: The 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 work: To study the usefulness of fiberoptic bronchoscopy in diagnosis of patients with mediastinal lymphadenopathy. Patients and methods: The 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. Results: 46.7% 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. Conclusion: The best diagnostic yield was obtained by combination of bronchial mucosal biopsy and TBNA techniques