Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

Abstract

Abstract:Background: The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in the diagnosis of patients with early (Stage 1) sarcoidosis. Methods: From 1995 to 2006, seven patients (two males, five females), with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis (mediastinal or hilar lymph nodes involvements without lung involvement) by histological examination of intrathoracic lymph nodes (LNs) and/or lung parenchyma taken from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results: All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satisfactory results. Conclusion: VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic alternative of transbronchial lung biopsy (TBLB), and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.

The role of EBUS‐TBNA and standard bronchoscopic modalities in the diagnosis of sarcoidosis

“…Therefore, tissue confirmation is crucial in patients with suspicious sarcoidosis. Mediastinoscopy is still a valuable tool in obtaining diagnostic material from the mediastinal lymph nodes (15,16). The sensitivity of mediastinoscopy in the diagnosis of sarcoidosis is very high and is estimated at 98%.…”

Sarcoidosis and its otolaryngological implications

“…Imaging techniques used in the diagnosis of sarcoidosis include CT (in the case of pulmonary sarcoidosis, HRCT: high resolution computerised tomography), MRI [magnetic resonance imaging (with gadolinium contrast)] and FDG-PET (positron emission tomography with Xuoro-2-deoxy-D-glucose) [61][62][63]. Imaging examinations via 67-radiogallium citrate scintigraphy is also used for the diagnosis of sarcoidosis [1][2][3][4][5][6][7][8]44].…”

Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases

“…Pleurodesis with talc through VATS or chest tube, or combination of both, can be effective, around 50% to 85% of successful rates in patients with hepatic hydrothorax (Milanez de Campos et al, 2000;Cerfolio and Bryant, 2006;Luh and Liu, 2006;Luh et al, 2007). Because talc is no longer permitted to be used at human body since 2000 in Taiwan, we used pleural electrocauterization for pleurodesis combined with postoperative minocin pleurodesis for some of our patients and can achieve equivalent results (Chen et al, 2008;Hsu et al, 2009).…”