Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis

Abstract

The objective of the current study was to assess the yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for the diagnosis of sarcoidosis in a large patient group.Bronchoscopy with transbronchial lung biopsy (TBLB) is nondiagnostic in 30% of patients with suspected sarcoidosis and has a risk of pneumothorax and haemoptysis. In order to obtain a diagnosis, mediastinoscopy is often performed as the next diagnostic procedure. EUS-FNA provides a nonsurgical alternative for the demonstration of noncaseating granulomas by aspirating mediastinal lymph nodes from the oesophagus.In total, 51 patients with suspected sarcoidosis stage I and II underwent EUS-FNA. Thirty-six patients (71%) previously underwent a nondiagnostic bronchoscopy. All patients were clinically followed (median 18 months) and surgical-pathological verification occurred in those patients with EUS aspirates that contained unrepresentative material.EUS-FNA demonstrated noncaseating granulomas without necrosis in 41 of 50 patients (82%) with the final diagnosis of sarcoidosis. Specific ultrasound features of clustered, well-demarcated iso-echoic lymph nodes were observed in 64% of patients with sarcoidosis. No complications occurred.Endoscopic ultrasound-guided fine-needle aspiration has a high yield in diagnosing sarcoidosis and qualifies as the next diagnostic step after a nondiagnostic bronchoscopy. The current authors expect that endoscopic ultrasound-guided fine-needle aspiration will reduce the number of mediastinoscopies for the diagnosis of sarcoidosis dramatically.

Comparison of conventional and ultrasound‑guided needle biopsy techniques in the diagnosis of sarcoidosis: a randomized trial

“…Studies on the di agnostic value of both endosonographic meth ods showed their high yield in the diagnosis of sarcoidosis. 13,14 There are only a few randomized controlled studies showing the superiority of EBUSTBNA over standard TBNA 19,20 and over routine bronchoscopic techniques including en dobronchial and transbronchial lung biopsy. 21 Only 2 small prospective studies reported a sig nificantly higher yield for EBUSTBNA (85%-94%) compared with TBLB (31%-37%) to detect granulomas.…”

“…6 However, risk and cost-benefit analyses and the development of minimally invasive endoscopic procedures such as conventional (standard) transbronchial nee dle aspiration (TBNA) and endoscopic ultrasound techniques such as endobronchial and endoscopic ultrasoundguided fine needle aspiration (EBUS TBNA and EUSFNA, respectively) have marked ly decreased the use of MS in this setting. [6][7][8][9][10][11][12][13][14] En dosonography was introduced into clinical prac tice after numerous studies and showed excellent results in lung cancer staging and very promis ing results in sarcoidosis. [13][14][15][16][17][18] However, it is un known which of the following minimally invasive endoscopic techniques-TBNA, EBUSTBNA, and EUSFNA-could be the method of choice in pa tients suspected of stage I or II sarcoidosis and what would be its sensitivity, specificity, accura cy, positive predictive value (PPV), and negative predictive value (NPV).…”

From the authors

“…The evolving consensus, corroborated by the current three studies [1][2][3], is that the role of both EBUS-TBNA and EUS-FNA will increase, whereas mediastinoscopy will substantially decrease, at least in centres that have the skills and the financial resources to offer EBUS-TBNA and EUS-FNA.…”

“…Obviously, and here we fully agree, there should be a consensus on the nomenclature of a new diagnostic method. The development of echo-endoscopes, which make accurate imaging and real-time controlled biopsies of lesions along the gastro-intestinal tract possible, is regarded as one of the greatest improvements in endoscopy of the last 20 yrs [1]. The name given to this technique was endoscopic ultrasonography or endoscopic ultrasound and was abbreviated as EUS.…”

“…Highjacking the ''E'' in EUS for ''endoscopic'' implies that ''oesophageal'' can be equated with ''endoscopic'', insinuating that the other endoscopic techniques are inferior. In the article by ANNEMA et al [1], which uses oesophageal US-guided sampling of mediastinal nodes for the diagnosis of sarcoidosis, it is stated in the conclusion that endoscopic (they mean oesophageal) US-guided (5EUS) fine-needle aspiration (FNA) should be the next step after a negative bronchoscopy. This conclusion was based on the fact that EUS had an impressive yield of 82% in sarcoidosis patients after a negative bronchoscopy.…”