Granulomatous inflammation in EBUS-FNA negatively predicts malignant nodal involvement in patients with co-existing past or present malignancy.

<bold>Background:</bold> Granulomatous inflammation in EBUS FNA in the background of thoracic and extrathoracic malignancy poses challenges in interpretation <bold>Aims & Objectives:</bold> To determine the significance of finding granulomatous inflammation in EBUS-FNA in the background of previous or active malignancy. <bold>Methods:</bold> Retrospective analysis of 3059 EBUS-TBNA cases from 2011-2018. <bold>Results:</bold> Of 142 (4.64%) samples which showed granulomatous inflammation, 32 (22.5%) cases were associated with malignancy. Imaging was available in 17 cases. Of these 17 cases, PET was done in 7 cases. All except one case showed indeterminate to low uptake. The exceptional case showed mediastinal nodes with an SUV max of 10.1, with associated radiological features of sarcoidosis. The mean nodal size was 15mm. The most frequent nodal stations were station 7 (73.9%), and station 4R (50.7%). Breast carcinomas (n=5), carcinoid tumours (n=4, 3- rectum, 1- lung), colorectal adenocarcinomas (n=4), melanoma (n=4) and primary lung adenocarcinoma (n=3) were some of the associated malignancies. One case showed both malignancy (Chronic lymphocytic leukemia, CLL) and granulomatous inflammation in the same node. <bold>Conclusion:</bold> Granulomatous inflammation in the nodal-FNA excluded the presence of metastasis of the primary malignancy in all but one case of CLL indicating a high negative predictive value in excluding metastases of the primary malignancy. However, further studies/systematic review is warranted to validate these findings given small sample size.