Tuberc Respir Dis.  2010 May;68(5):267-272.

Pulmonary Sarcoidosis Diagnosed by Endobronchial Ultrasound Fine Needle Aspiration

• Kim WY
• Chang YJ
• Lyu JW
• Park YS
• Jang SJ
• Song JW
• Oh YM
• Shim TS
• Lee SD
• Kim WS
• Kim DS
• Choi CM

Abstract

BACKGROUND
Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis.
METHODS
Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis.
RESULTS
A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure.
CONCLUSION
EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

Keyword

Bronchoscopy; Biopsy, Fine-Needle; Sarcoidosis, Pulmonary

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Bronchoalveolar Lavage
Bronchoscopes
Bronchoscopy
Granuloma
Humans
Lung
Lymph Nodes
Lymphatic Diseases
Mediastinoscopy
Needles
Sarcoidosis
Sarcoidosis, Pulmonary
Thoracoscopy

Figure

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  Figure 1 Epithelial non-caseating granuloma consistent with sarcoidosis (H&E stain, ×200).

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  Figure 2 Well defined, homogenous lymph node in endobronchial ultrasound.

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  Figure 3 All patients were diagnosed as sarcoidosis in different methods. EBUS-TBNA: endobronchial ultrasound transbronchial needle aspiration; TBLB: transbronchial lung biopsy; VATS: video-assisted thoracoscopic surgery.

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