Cytologic Assessment of Endobronchial Ultrasound-guided Transbronchial Needle Aspirates in Sarcoidosis

Chee, Alex; Khalil, Moosa; Stather, David R.; MacEachern, Paul; Field, Stephen K.; Tremblay, Alain

doi:10.1097/lbr.0b013e3182442925

Cited by 30 publications

(24 citation statements)

References 18 publications

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“…In this study, sampling more than one lymph node station was the only variable significantly associated with the likelihood of a positive aspirate. This finding was indirectly confirmed by Tremblay and colleagues [56], who performed a randomized trial to primarily compare the yield of EBUS-TBNA versus TBNA in suspected sarcoidosis patients and suggested that the superiority of EBUS-TBNA could have been related to the greater average number of lymph node stations sampled.…”

Section: Discussionsupporting

confidence: 56%

Transbronchial Needle Aspiration: A Systematic Review on Predictors of a Successful Aspirate

et al. 2013

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Background: Transbronchial needle aspiration (TBNA) is a safe and useful sampling technique for the diagnosis of mediastinal adenopathies/masses, but its accuracy seems to be influenced by selected clinical and procedural aspects. Objectives: We performed a systematic review to identify the main predictors of a successful transbronchial aspirate according to different clinical settings. Methods: We searched Medline and Embase for all studies evaluating predictors of TBNA diagnostic yield, published up to February 2012. Two authors reviewed all titles/abstracts and retrieved the full text of articles that are potentially relevant to identify studies according to predefined selection criteria. The methodological quality of studies was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool. Evidence synthesis was graded according to overall number of studies, patients involved and methodological features. Results: Fifty-three studies, involving more than 8,000 patients and evaluating 23 potential predictive factors, were included. Major predictors in an unselected population, as well as in patients with suspected/known lung cancer, included lymph node size (short axis length ≥2 cm), presence of abnormal endoscopic findings, subcarinal and right paratracheal location, and the use of histological needle by an experienced bronchoscopist. Stage I and sampling of more than one lymph node stations were the only predictors of a successful TBNA result in patients with suspected sarcoidosis. Conclusions: The diagnostic yield of TBNA depends on selected clinical and procedural features. Knowledge of factors that predict a positive TBNA result may help optimize the diagnostic success of the procedure in different clinical settings.

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Section: Discussionsupporting

confidence: 56%

Transbronchial Needle Aspiration: A Systematic Review on Predictors of a Successful Aspirate

et al. 2013

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“…In most of the previous studies that have looked at the success of the procedure according to the disease stage, the yield of TBNA, EBUS-TBNA, and EUS-FNA from intrathoracic adenopathy was shown to be consistently higher in stage I than in stage II sarcoidosis by a rate ranging from 7 to 36% [8,9,11,12,14,20,22,24]. The observation in the present study that granulomas in the lymph nodes of stage I patients tended to be larger and to have a higher density than those in stage II may provide a plausible explanation for the extra yield of TBNA in stage I disease.…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of a study specifically designed to evaluate the impact of various preparation methods in this setting, the extent to which any observed differences are true rather than related to local preference and experience with a given method is difficult to establish. Furthermore, a review of the pertinent literature revealed that sarcoidal granulomas were reliably and effectively identified regardless of the fact that the material obtained with both conventional and ultrasound-guided TBNA was exclusively smeared onto slides [7,8,9,13,14,15,16,17,18,19,20,21], partly smeared onto slides, and partly used to prepare cell blocks [22,32,33], or processed as ThinPrep and cell blocks [22,24]. …”

Section: Discussionmentioning

confidence: 99%

“…In a randomized controlled trial of conventional versus EBUS-guided TBNA in the diagnosis of sarcoidosis, for instance, Tremblay et al [23] made the key observation that the identification of granulomas in the same cytological material was significantly different among the two pathologists involved in the study, both in the per-patient analysis and in the per-lymph node analysis [24]. In the more clinically important per-patient analysis, in particular, the yield of TBNA and EBUS-TBNA rose from 53 to 73% and from 83 to 95%, respectively, when the cytologic material was examined by a pathologist experienced in lung diseases.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, there has been a shift towards the use of TBNA cytology samples obtained using smaller gauge needles (21- and 22-gauge). Despite several published studies relying on cytologic material obtained with TBNA and EBUS- TBNA to diagnose both sarcoidal and tubercular lymphadenopathy [8,9,13,14,15,16,17,18,19,20,21,22], clinical experience and literature data suggest that the interobserver variability in the identification of granulomas on cytological samples from intrathoracic lymphadenopathy can be considerable among pathologists [23,24]. …”

Section: Introductionmentioning

confidence: 99%

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Sarcoidal Granulomas in Cytological Specimens from Intrathoracic Adenopathy: Morphologic Characteristics and Radiographic Correlations

Cancellieri¹,

Leslie

Tinelli

et al. 2012

Respiration

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Background: Clinical experience and literature data suggest that the ability of pathologists to identify granulomas in cytological specimens from intrathoracic lymphadenopathy varies considerably and may negatively influence the yield of transbronchial needle aspiration (TBNA), both conventional and ultrasound-guided (EBUS-TBNA). Objectives: To describe the cytomorphology of sarcoidal granulomas on TBNA cytology specimens and to analyze the presence of associations between the cytological characteristics of granulomas and the radiographic stage of sarcoidosis. Methods: TBNA cytological specimens from 123 sarcoidosis patients and 14 tuberculosis patients (control population) were reviewed independently by two pathologists blinded to the clinical-radiological details. Results: Sarcoidal granulomas were small [median (IQR) largest diameter: 0.478 (0.318-0.701) mm] and well-formed, round or elliptical in shape, and almost invariably had a regular contour. Background elements lacked necrotic debris or exudate. The density [median (IQR) number of granulomas per slide: 6.85 (3.66-11) vs. 5.25 (2.5-8), p = 0.073] and size [median (IQR) largest diameter: 0.51 (0.319-0.733) vs. 0.398 (0.318-0.522), p = 0.071] tended to be larger in stage I than in stage II sarcoidosis. A necrotic background was common in the tuberculosis cohort studied (79 vs. 0%, p < 0.0001). Conclusions: Granulomas can be reliably identified on TBNA cytological material once their characteristic cytomorphology is delineated. A higher density of granulomas in lymphadenopathy of stage I sarcoidosis patients could partly explain the higher success rate constantly obtained by TBNA and EBUS-TBNA in this stage of the disease. A necrotic background suggests a tubercular etiology of the granulomas over a sarcoidal one, in the appropriate clinical setting.

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Endosonography vs Conventional Bronchoscopy for the Diagnosis of Sarcoidosis

Bartheld

Dekkers

Szlubowski

et al. 2013

JAMA

212

142

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Importance Tissue verification of noncaseating granulomas is recommended for the diagnosis of sarcoidosis. Bronchoscopy with transbronchial lung biopsies, the current diagnostic standard, has moderate sensitivity in assessing granulomas. Endosonography with intrathoracic nodal aspiration appears to be a promising diagnostic technique. ObjectiveTo evaluate the diagnostic yield of bronchoscopy vs endosonography in the diagnosis of stage I/II sarcoidosis. Design, Setting, and Patients Randomized clinical multicenter trial (14 centers in 6 countries) between March 2009 and November 2011 of 304 consecutive patients with suspected pulmonary sarcoidosis (stage I/II) in whom tissue confirmation of noncaseating granulomas was indicated.Interventions Either bronchoscopy with transbronchial and endobronchial lung biopsies or endosonography (esophageal or endobronchial ultrasonography) with aspiration of intrathoracic lymph nodes. All patients also underwent bronchoalveolar lavage. Main Outcomes and MeasuresThe primary outcome was the diagnostic yield for detecting noncaseating granulomas in patients with a final diagnosis of sarcoidosis. The diagnosis was based on final clinical judgment by the treating physician, according to all available information (including findings from initial bronchoscopy or endosonography). Secondary outcomes were the complication rate in both groups and sensitivity and specificity of bronchoalveolar lavage in the diagnosis of sarcoidosis.Results A total of 149 patients were randomized to bronchoscopy and 155 to endosonography. Significantly more granulomas were detected at endosonography vs bronchoscopy (114 vs 72 patients; 74% vs 48%; PϽ.001). Diagnostic yield to detect granulomas for endosonography was 80% (95% CI, 73%-86%); for bronchoscopy, 53% (95% CI, 45%-61%) (PϽ.001). Two serious adverse events occurred in the bronchoscopy group and 1 in the endosonography group; all patients recovered completely. Sensitivity of the bronchoalveolar lavage for sarcoidosis based on CD4/CD8 ratio was 54% (95% CI, 46%-62%) for flow cytometry and 24% (95% CI, 16%-34%) for cytospin analysis. Conclusion and RelevanceAmong patients with suspected stage I/II pulmonary sarcoidosis undergoing tissue confirmation, the use of endosonographic nodal aspiration compared with bronchoscopic biopsy resulted in greater diagnostic yield.

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Cytologic Assessment of Endobronchial Ultrasound-guided Transbronchial Needle Aspirates in Sarcoidosis

Cited by 30 publications

References 18 publications

Transbronchial Needle Aspiration: A Systematic Review on Predictors of a Successful Aspirate

Transbronchial Needle Aspiration: A Systematic Review on Predictors of a Successful Aspirate

Sarcoidal Granulomas in Cytological Specimens from Intrathoracic Adenopathy: Morphologic Characteristics and Radiographic Correlations

Endosonography vs Conventional Bronchoscopy for the Diagnosis of Sarcoidosis

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