Endobronchial Biopsy for Sarcoidosis

Shorr, Andrew F.; Torrington, Kenneth G.; Hnatiuk, Oleh W.

doi:10.1378/chest.120.1.109

Cited by 146 publications

(108 citation statements)

References 15 publications

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“…EBB had a low diagnostic accuracy of 29%, which is very similar to our previous study which reported a diagnostic yield of 27% [18]. SHORR et al [8] reported EBB alone to have a diagnostic yield of 61.8%. In their study EBB findings were more frequently positive in abnormal appearing airways.…”

Section: Discussionsupporting

confidence: 89%

“…In their study EBB findings were more frequently positive in abnormal appearing airways. However, biopsy of normal appearing bronchial mucosa provided diagnostic tissue in 30% of their patients [8]. This is similar to our cohort, in which the majority of patients had normal appearing mucosa.…”

Section: Discussionsupporting

confidence: 87%

“…As the published diagnostic yield of TBLB has ranged from 32% to 100% [4][5][6][7][8][9][10], we calculated that o58 patients were required to have an 80% chance (1-b) of detecting a significant (p,0.05) 30% difference in primary outcome measure between TBLB and EBUS-TBNA. The diagnostic accuracy rate was calculated according to standard definitions.…”

Section: Discussionmentioning

confidence: 99%

“…In a large meta-analysis, mediastinoscopy was associated with a median complication rate of 2% and was highly dependent on the experience and skill of the surgeon [3]. The diagnostic yield of transbronchial lung biopsies (TBLB), often taken with endobronchial biopsies (EBB), is highly variable and operator dependent, ranging from 32% to 100% [4][5][6][7][8][9][10], and is associated with a pneumothorax rate of o1.4% and haemorrhage in 4% of patients, even in units that undertake this procedure in large numbers of patients [11]. Bronchoalveolar lavage is a low-risk investigational tool, but has a sensitivity of only 53-59% for sarcoidosis [12].…”

Section: Introductionmentioning

confidence: 99%

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Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

et al. 2012

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Rapid on-site evaluation (ROSE) of endobronchial ultrasound-guided transbronchial needle aspirates (EBUS-TBNA) has not been compared to final detailed cytological analysis in patients with suspected sarcoidosis.To assess the diagnostic accuracy of EBUS-TBNA with ROSE in patients with suspected sarcoidosis, a prospective two-centre study performed EBUS-TBNA with ROSE of cellular material followed by transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB). The diagnostic accuracy of EBUS-TBNA with ROSE was compared to the final cytological assessment and to TBLB and EBB.Analysis confirmed 49 out of 60 cases of sarcoidosis. ROSE sensitivity was 87.8% (specificity 91%, positive predictive value 97.7%). ROSE slide interpretation in combination with the final fixed slide and cell block preparations had a sensitivity of 91.8% (specificity 100%, positive predictive value 100%). 67% of patients were confirmed as having sarcoidosis on TBLB and 29% on EBB. Interobserver agreement between cytotechnologists and pathologists was very good (k50.91, 95% CI 0.80-1.0 and k50.91, 95% CI 0.79-1.0, respectively).EBUS-TBNA with ROSE has high diagnostic accuracy and interobserver agreement and informs the bronchoscopist in theatre whether additional diagnostic procedures need to be undertaken. EBUS-TBNA with ROSE should therefore be considered as the first-line investigation of sarcoidosis. @ERSpublications Rapid on-site evaluation of EBUS-TBNA should be first-line investigation in sarcoidosis

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

et al. 2012

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“…6,7 Genel anestezi gerektirmemesi, kolay uygulanabilir oluşu, yüksek tanı getirisi, düşük komplikasyon oranı nedeni ile bronkoskopi sarkoidoza yönelik tanısal invaziv iş-lemler arasında ilk sırada yer almaktadır. [8][9][10] Sarkoidozda uygulanan bronkoskopik tetkikler içinde mukoza biyopsisi (MB), transbronşiyal biyopsi (TBB), LN transbronşiyal iğne aspirasyonu (TBİA) teknikleri yer almaktadır. 11 Olgularda bu tetkiklerden en az birinde histopatolojik olarak kazeifikasyon içermeyen granülomatöz inflamasyon gösterilmesi ile bronkoskopik yöntemlerle sarkoidoz tanısı konulmuş olur.…”

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The Relationship Between Diagnostic Efficiency of Bronchoscopy with Clinical and Radiological Findings in Pulmonary Sarcoidosis

Öcal¹,

Bilgiç²,

Tozkoparan³

et al. 2015

Turkiye Klinikleri Arch Lung

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Ö ÖZ ZE ET T A Am ma aç ç: : Sarkoidozun kesin tanısı için histopatolojik incelemede kazeifikasyon göstermeyen epiteloid hücreli granülom yapısının gösterilmesi gereklidir. Bu açıdan; akciğer sarkoidozu kuşkusu olan tüm olgularda bronkoskopi endikasyonu mevcuttur. Seçilecek olan bronkoskopik tekniğin, olgunun klinik ve radyolojik özellikleri ile birlikte değerlendirilmesi önemlidir. Bu çalışmada, olguların radyolojik yaygın-lığı ve ağırlığı, klinik ağırlığı, laboratuvar tetkik sonuçları ile bronkoskopik tetkiklerin tanısal verimlilikleri arasında olası bir ilişkinin ortaya konması hedeflenmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Değerlendirmeye alınan 103 hastanın PA akciğer grafisi, Toraks bilgisayarlı tomografi/yüksek rezolüsyonlu bilgisayarlı tomografileri, spirometri, DLCO, arteriyel kan gazı tahlilleri, biyokimyasal tetkikleri, kötü prognoz kriteri varlığı, bronkoskopik işlemdeki biyopsi tekniği ve sonuçları retrospektif olarak incelenmiştir. B Bu ul lg gu ul la ar r: : Bronkoskopi tanısal verimliliği %91,8 gibi yüksek bir değerde bulunmuştur. Mukoza biyopsisi, transbronşiyal biyopsi ve transbronşiyal iğne aspirasyonunun tek başlarına tanıya katkıları sırasıyla %12,2, %34,4 ve %8,8 olarak bulunmuştur. Transbronşiyal biyopsi tanısal verimliliği Evre 1 hastalarda Evre 2 hastalardaki kadar yüksek olup, tüm evrelerde en yüksek tanısal verimliliğe sahip yöntem olarak izlenmiştir. Radyolojik yaygınlık ile transbronşiyal biyopsi tanısallığı arasında anlamlı bir ilişki bulunmamış-tır. Mukozal lezyonu olan hastalardaki mukoza biyopsisi tanısal verimliliği anlamlı derecede yüksek izlenmiştir (p<0,05). Mukozal lezyon mevcudiyeti ve mukoza biyopsisi tanısallığının, klinik ve total radyolojik ağırlık ile aralarında anlamlı ilişki saptanmamakla birlikte, fissür çevresinde yer alan mikronodüller, mukoza biyopsisi pozitif olan grupta anlamlı derecede yüksek izlenmiştir (p<0,01). S So on nu uç ç: : Her bir tanısal bronkoskopik tetkikin tanıya tek başına katkısının mevcut olduğu göz önünde bulundurularak uygun hastalarda mümkün olduğunca her üç tetkiki de uygulamanın tanısal verimliliği artıracağı söyle-nebilir. Bu konuda daha geniş, çok-merkezli, prospektif çalışmalar ile sonuçlar geliştirilebilir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Biyopsi; bronkoskopi; sarkoidoz A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Diagnosis of sarcoidosis can be made by histopathological confirmation of granulomas without caseification necrosis. Bronchoscopy is indicated in patients with pulmonary sarcoidosis suspicion. In this study, we aimed to identify if there is a relationship between clinical and laboratory findings, radiological extent and weight with diagnostic efficacy of bronchoscopy in pulmonary sarcoidosis. M Ma at te e--r ri ia al l a an nd d M Me et th ho od ds s: : Chest X-ray and thorax computed tomography/high-resolution computed tomography findings, spirometry, DLCO, arterial blood gas, biochemical test results, presence of poor prognosis criteria, bronchoscopic technique res...

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Diagnosis and Treatment of Pulmonary Sarcoidosis

Belperio

Shaikh

Abtin

et al. 2022

JAMA

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ImportanceSarcoidosis is an inflammatory granulomatous disease of unknown cause that affects an estimated 2 to 160 people per 100 000 worldwide and can involve virtually any organ. Approximately 10% to 30% of patients with sarcoidosis develop progressive pulmonary disease.ObservationAmong patients with pulmonary sarcoidosis, the rate of spontaneous remission without serious sequelae ranges from 10% to 82%. However, lung disease progression occurs in more than 10% of patients and can result in fibrocystic architectural distortion of the lung, which is associated with a mortality rate of 12% to 18% within 5 years. Overall, the mortality rate for sarcoidosis is approximately 7% within a 5-year follow-up period. Worldwide, more than 60% of deaths from sarcoidosis are due to pulmonary involvement; however, more than 70% of deaths from sarcoidosis are due to cardiac involvement in Japan. Up to 70% of patients with advanced pulmonary sarcoidosis develop precapillary pulmonary hypertension, which is associated with a 5-year mortality rate of approximately 40%. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues. Although optimal doses of oral glucocorticoids for pulmonary sarcoidosis are unknown, oral prednisone typically starting at a dose of 20 mg/d to 40 mg/d for 2 to 6 weeks is recommended for patients who are symptomatic (cough, dyspnea, and chest pain) and have parenchymal infiltrates and abnormal pulmonary function test results. Oral glucocorticoids can be tapered over 6 to 18 months if symptoms, pulmonary function test results, and radiographs improve. Prolonged use of oral glucocorticoids may be required to control symptoms and stabilize disease. Patients without adequate improvement while receiving a dose of prednisone of 10 mg/d or greater or those with adverse effects due to glucocorticoids may be prescribed immunosuppressive agents, such as methotrexate, azathioprine, or an anti–tumor necrosis factor medication, either alone or with glucocorticoids combined with appropriate microbial prophylaxis for Pneumocystis jiroveci and herpes zoster. Effective treatments are not available for advanced fibrocystic pulmonary disease.Conclusions and RelevanceSarcoidosis has a mortality rate of approximately 7% within a 5-year follow-up period. More than 10% of patients with pulmonary sarcoidosis develop progressive disease and more than 60% of deaths are due to advanced pulmonary sarcoidosis. Oral glucocorticoids with or without another immunosuppressive agent are the first-line therapy for symptomatic patients with abnormal pulmonary function test results and lung infiltrates. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues.

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Endobronchial Biopsy for Sarcoidosis

Cited by 146 publications

References 15 publications

Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

The Relationship Between Diagnostic Efficiency of Bronchoscopy with Clinical and Radiological Findings in Pulmonary Sarcoidosis

Diagnosis and Treatment of Pulmonary Sarcoidosis

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