Background: Mediastinal lymphadenopathy indicates an intrathoracic pathological process. Tuberculous mediastinal lymphadenopathy (TML) can be an early sign of tuberculosis infection, particularly in developing countries. Its incidence is often unclear due to underdiagnosis and limited access to diagnostic tools. Timely diagnosis is essential, as delayed treatment can result in severe complications. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a reliable method for obtaining samples and establishing a diagnosis, although its use is constrained by various factors. This study aims to clarify the role of EBUS features in assessing TML. Methods: This is a cross-sectional study that recruited ≥18 years old patients with suspected TML who underwent EBUS-TBNA. Mediastinal lymph nodes were systematically evaluated EBUS, with a focus on the largest nodes for further characteristic analysis. A TBNA was performed, and the retracted samples were assessed for pathology, acid-fast bacilli, Mycobacterium tuberculosis (MTB) culture, and Xpert Ultra examinations. Results: One hundred patients were recruited for the study. Fifty-three of these patients were ultimately diagnosed with TML. Significant associations were found between TML and several factors: short-axis size (p<0.001), oval-shaped lymph nodes (p=0.034), indistinct margins (p<0.001), central hilar presentation (p<0.001), internal echoes (p<0.049), thin layer echogenicity (p=0.033), and nodal matting (p<0.001). Among the diagnostic modalities, Xpert Ultra demonstrated the highest sensitivity for TML at 71.7%. Conclusion Endobronchial ultrasonographic features such as small size, round shape, indistinct margin, central hilar presentation, internal echo, thin layer echogenicity, and nodal matting are indicative of TML.

Tuberculosis (TB) is one of the leading causes of adult death in the Asia-Pacific Region, including Indonesia. As an infectious disease caused by Mycobacterium tuberculosis (MTB), TB remains a major public health issue especially in developing nations due to the lack of adequate diagnostic testing facilities. Diagnosis of TB has entered an era of molecular detection that provides faster and more cost-effective methods to diagnose and confirm drug resistance in TB cases, meanwhile, diagnosis by conventional culture systems requires several weeks. New advances in the molecular detection of TB, including the faster and simpler nucleic acid amplification test (NAAT) and whole-genome sequencing (WGS), have resulted in a shorter time for diagnosis and, therefore, faster TB treatments. In this review, we explored the current findings on molecular diagnosis of TB and drug-resistant TB to see how this advancement could be integrated into public health systems in order to control TB.
Adult ; Communicable Diseases ; Developing Countries ; Diagnosis ; Diagnostic Tests, Routine ; Drug Resistance ; Humans ; Indonesia ; Mycobacterium tuberculosis ; Nucleic Acid Amplification Techniques ; Public Health ; Tuberculosis ; Tuberculosis, Multidrug-Resistant