Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think?

Abstract

Background: Preliminary data show that endosonography guided fine needle aspiration (EUS-FNA) may be an accurate method for diagnosing sarcoidosis. However, these data were obtained in a small selected group of patients with a very high pretest probability of sarcoidosis. This retrospective study reports on the use of EUS-FNA in an unselected group of patients with mediastinal lymphadenopathy of unknown origin. Methods: The EUS database of a single tertiary referral centre was reviewed for patients who underwent EUS-FNA for mediastinal lymphadenopathy of unknown origin. Clinical presentation and imaging studies of each case were carefully reviewed and the diagnosis ''sarcoidosis'' or ''no sarcoidosis'' attributed if possible. The diagnoses were compared with the result of EUS-FNA. Results: One hundred and twenty four patients were investigated. In 35 cases EUS-FNA identified granulomas (group 1); in the other 89 cases (group 2) no granulomas were detected. The definite diagnoses in group 1 were sarcoidosis (n = 25), indefinite (n = 7), no sarcoidosis (n = 3). The definite diagnoses in group 2 were sarcoidosis (n = 3), indefinite (n = 9), no sarcoidosis (n = 77). Of the 77 cases with no sarcoidosis, 44 were diagnosed with other diseases. The other 33 showed non-specific changes in the FNA and sarcoidosis was excluded by negative non-EUS pathology (n = 17) and clinical presentation. The sensitivity and specificity for EUS-FNA were 89% (95% CI 82 to 94) and 96% (95% CI 91 to 98), respectively, after exclusion of the indefinite cases in both groups. Conclusions: EUS-FNA is an accurate method for diagnosing sarcoidosis in an unselected group of patients with mediastinal lymphadenopathy. The reported sensitivity and specificity must be appreciated in the context of the difficult and often incomplete clinical diagnosis of sarcoidosis.

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

“…In 64% of patients with the final diagnosis of sarcoidosis, multiple, clustered LNs, with a homogenous iso-echoic echo texture with well-demarcated margins ( fig. 2) were observed, as described in seven patients by MISHRA et al [14]. To the current authors, these EUS features are highly predictive for sarcoidosis as they are different from those of malignant LNs but further studies have to confirm these findings.…”

“…This corresponds with the results of a recently published study in patients with enlarged mediastinal LNs of unknown origin where the sensitivity and specificity for EUS-FNA was 89% and 96% [14]. Limitations of the latter study are its retrospective design and the fact that in addition to 28 patients with the final diagnosis of sarcoidosis, the final diagnosis was indefinite in 16 patients.…”

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

“…With a higher diagnostic yield and minimal complications, EUS-FNA has been used in the diagnosis of mediastinal lymphadenopathy in benign disease. Recent trials of EUS-FNA in sarcoidosis showed a diagnostic value of 82% [13], sensitivity of 89-100% and specificity of 94-96% [24,25]. Lymphadenopathies in sarcoidosis are typically hilar, and involvement of right paratracheal and aorto-pulmonary window lymph nodes is common (70-76%) [26].…”

The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis

“…Recent reports show that, with either curvilinear transoesophageal endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) (EUS-FNA) or endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) (EBUS-TBNA), together referred to hereafter as E(B)US, noncaseating granulomas can be demonstrated upon sampling of the intrathoracic nodes and that, as such, these techniques can contribute to the diagnosis of sarcoidosis [6][7][8][9][10]. Although these reports indicate feasibility, none of them assessed the value of these techniques in routine daily practice, where bronchoscopy remains the first diagnostic step [1].…”