Chest
ORIGINAL RESEARCHINTERVENTIONAL PULMONOLOGYEndobronchial Ultrasound for the Diagnosis of Pulmonary Sarcoidosis
Section snippets
Study Design
This study reports the results of consecutive patients who underwent EBUS-TBNA in whom sarcoidosis was considered to be the leading preprocedure diagnosis. By February 2005, it had become our anecdotal experience that EBUS-TBNA was a powerful and safe technique for the diagnosis of pulmonary sarcoidosis. Our pulmonary division therefore decided at that time that it would be our standard diagnostic approach. The study was approved by the institutional review board of the Medical University of
Results
During the study period, 50 EBUS procedures were performed in which sarcoidosis was thought to be the most likely diagnosis. Patient characteristics are noted in Table 1 . In 45 of 50 patients (90%), the indication for bronchoscopy was clinical symptoms and adenopathy on radiographic imaging. Five patients had asymptomatic mediastinal and/or hilar adenopathy that was radiographically suspicious for pulmonary sarcoidosis, but they also had a medical history of malignancy, latent tuberculosis,
Discussion
This study demonstrates that EBUS-TBNA of mediastinal and/or hilar lymph nodes has a high yield for the detection of granulomatous inflammation in cases of suspected pulmonary sarcoidosis, and is associated with low morbidity. In our study, EBUS-TBNA confirmed the clinical diagnosis of sarcoidosis in 41 of 48 patients. The diagnostic accuracy of EBUS-TBNA was 85% in our study population. The addition of EBUS-targeted TBNA and/or TBLB increased the yield to 94% but was rarely needed. There are
Conclusion
EBUS-TBNA is a high-yield, safe modality for diagnosing noncaseating, epithelioid granulomas in patients with a high clinical suspicion for pulmonary sarcoidosis. EBUS-TBNA has many theoretical advantages over other diagnostic techniques in terms of diagnostic yield and morbidity, which we suspect will make it the diagnostic procedure of choice. As with all diagnostic approaches to sarcoidosis, a biopsy specimen showing granulomatous inflammation must be viewed in context with all of the
References (28)
- et al.
Pulmonary sarcoidosis
Clin Chest Med
(1997) - et al.
Flexible transbronchial needle aspiration in the diagnosis of sarcoidosis
Chest
(1994) - et al.
Bronchoscopy in North America: the ACCP survey
Chest
(1991) - et al.
Mediastinoscopy as a routine outpatient procedure
Ann Thorac Surg
(1994) - et al.
Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial
Chest
(2004) - et al.
Endobronchial biopsy for sarcoidosis: a prospective study
Chest
(2001) - et al.
Bronchoalveolar lavage. Still useful in diagnosing sarcoidosis?
Clin Chest Med
(1997) - et al.
Mediastinoscopy vs thoracoscopy for mediastinal biopsy: results of a prospective nonrandomized study
Chest
(1996) - et al.
Mediastinoscopy in patients with presumptive stage I sarcoidosis: a risk/benefit, cost/benefit analysis
Chest
(1998) - et al.
Diagnosis of sarcoidosis: when is a peek good enough?
Chest
(2000)
ATS/ERS/WASOG statement on sarcoidosis: American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders
Sarcoidosis Vasc Diffuse Lung Dis
ATS/ERS/WASOG statement on sarcoidosis: Sarcoidosis Statement Committee; American Thoracic Society, European Respiratory Society, and World Association for Sarcoidosis and Other Granulomatous Disorders
Eur Respir J
Transbronchial needle aspiration improves the diagnostic yield of bronchoscopy in sarcoidosis
Sarcoidosis Vasc Diffuse Lung Dis
Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes
Thorax
Cited by (0)
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.