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Endobronchial Ultrasound for the Diagnosis of Pulmonary Sarcoidosis^*

^* From the Division of Pulmonary and Critical Care Medicine (Drs. Garwood, Judson, Silvestri, and Doelken) and the Department of Pathology (Drs. Hoda and Fraig), Medical University of South Carolina, Charleston, SC.

Correspondence to: Marc A. Judson, MD, FCCP, Medical University of South Carolina, Pulmonary and Critical Care, CSB-812, 96 Jonathan Lucas St, Charleston, SC 29425; e-mail: judsonma{at}musc.edu

Abstract

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.

Key Words: bronchoscopy • diagnosis • endobronchial ultrasound • sarcoidosis

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