Chest
Volume 132, Issue 4, October 2007, Pages 1298-1304
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ORIGINAL RESEARCH
INTERVENTIONAL PULMONOLOGY
Endobronchial Ultrasound for the Diagnosis of Pulmonary Sarcoidosis

https://doi.org/10.1378/chest.07-0998Get rights and content

Background

The diagnosis of pulmonary sarcoidosis can be established by a variety of techniques. Transbronchial lung biopsy is often the preferred approach, but it is frequently nondiagnostic and carries a risk of pneumothorax and bleeding. Mediastinoscopy is often suggested as the next diagnostic step but entails significant cost and associated morbidity. Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) is emerging as a safe, minimally invasive tool for the primary diagnosis of mediastinal and hilar lymphadenopathy. The purpose of this study was to assess the utility of EBUS-TBNA for pulmonary sarcoidosis.

Methods

Fifty consecutive patients who had been referred for EBUS-TBNA for suspected pulmonary sarcoidosis were included in the study. On-site cytology was used to assess the adequacy of the samples. The presence of noncaseating granulomas without necrosis in the appropriate clinical setting was deemed to be adequate for the diagnosis of pulmonary sarcoidosis. Patients with a negative EBUS-TBNA underwent further histologic biopsy or clinical follow-up to determine the final diagnosis.

Results

Eighty-two lymph nodes with a median size of 16 mm (range, 4 to 40 mm) were punctured. EBUS-TBNA demonstrated noncaseating granulomas without necrosis in 41 of 48 patients (85%) with a final diagnosis of sarcoidosis. EBUS-TBNA, therefore, has a sensitivity of 85% for the primary diagnosis of pulmonary sarcoidosis.

Conclusions

EBUS-TBNA is a safe, minimally invasive tool for the primary diagnosis of pulmonary sarcoidosis that has a high diagnostic yield. EBUS-TBNA should be considered an appropriate alternative diagnostic technique for patients with suspected 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

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  • 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.

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