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Endobronchial Ultrasound for the Diagnosis of Pulmonary Sarcoidosis

¹Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC ²Department of Pathology, Medical University of South Carolina, Charleston, SC

garwood{at}musc.edu

Abstract

BACKGROUNDThe diagnosis of pulmonary sarcoidosis can be established by a variety of techniques. Transbronchial lung biopsy is often the preferred approach, but it is frequently non-diagnostic 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 with transbronchial needle aspiration (EBUS-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.

METHODSFifty consecutive patients referred for EBUS-TBNA for suspected pulmonary sarcoidosis were included in the study. On-site cytology was used to assess adequacy of the samples. The presence of non-caseating granulomas without necrosis in the appropriate clinical setting was deemed 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.

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

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

Key Words: Sarcoidosis • Diagnosis • Bronchoscopy • Endobronchial ultrasound

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