Endosonographic characteristics of mediastinal lymph nodes for predicting malignancy in high tuberculosis burden settings: a study of 774 subjects

Background Whether sonographic features of mediastinal lymph nodes can differentiate malignancy from tuberculosis remains unclear. Research design and methods We retrospectively identified subjects with a confirmed diagnosis of tuberculosis or malignancy on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Our primary objective was to compare the endosonographic characteristics of lymph nodes on EBUS between tuberculosis and malignancy. Our secondary objective was to assess the diagnostic performance of endosonographic characteristics in predicting malignancy. Results We included 774 subjects (1,498 lymph nodes) with a confirmed diagnosis of tuberculosis (n = 497) or malignancy (n = 277). Distinct lymph node margins (84.1% vs. 93.8%, P Conclusions Endosonographic characteristics, such as round shape and the coagulation necrosis sign, are not specific for malignancy in high tuberculosis prevalence areas.