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EBUS-TBNA Cytology Specimens are Predictive of Occupational Dust Exposure in Patients With Bilateral Mediastinal and Hilar Lymphadenopathy

Pattison, Andrew, FRACP; Cook, Alistair, MBBS; Singh, Mahendra, FRCPA; Nandakumar, Lakshmy, FRCPA; Ravi Kumar, Aravind, FRACP; Fielding, David, MD

Journal of Occupational and Environmental Medicine: October 2018 - Volume 60 - Issue 10 - p 880–885
doi: 10.1097/JOM.0000000000001388

Objectives: The aim of this study was to describe the cytological features of patients with significant occupational dust exposure presenting with benign bilateral mediastinal and hilar lymphadenopathy (BHL).

Methods: A retrospective cohort study including patients undergoing EBUS-TBNA for investigation of benign BHL. Patient characteristics, dust exposure history, radiology, and cytology samples from EBUS-TBNA were assessed.

Results: EBUS-TBNA cytology in patients with exposure showed a significant increase in the presence of birefringent fibers (60.7% vs 19.2%, P = 0.001) and intracellular carbon pigment (75.0% vs 28.9%, P = 0.001) compared with patients without exposure. The presence of these two features together yielded a sensitivity of 53.6% and a specificity of 88.5%.

Conclusion: In patients with BHL and a history of occupational dust exposure, the presence of birefringent fibers and intracellular carbon pigment in EBUS-TBNA cytology samples may assist in a diagnosis of lymphadenopathy due to occupational dust exposure.

Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia (Dr Pattison, Dr Cook, Dr Fielding), Department of Anatomical Pathology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia (Dr Singh, Dr Nandakumar), and Department of Nuclear Medicine and Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia (Dr. Ravi Kumar).

Address correspondence to: Andrew Pattison, FRACP, Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Butterfield St, Herston, QLD, Australia, 4006 (

No funding sources or pharmaceutical/industry support was provided for this study.

Pattison, Cook, Singh, Nandakumar, Ravi Kumar, and Fielding have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2018 by the American College of Occupational and Environmental Medicine