Mediastinoscopy in Patients With Presumptive Stage I Sarcoidosis

Reich, Jerome M.; Brouns, Matthew; O’Connor, Elizabeth; Edwards, Miles J.

doi:10.1378/chest.113.1.147

Cited by 107 publications

(73 citation statements)

References 34 publications

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“…The published literature may underestimate the morbidity/mortality of this procedure, which is highly dependent on the experience and skill of the operator, possibly due to the reports of institutions with large and favorable experiences. In a meta-analysis, it is been found that total complications were ranged from 1.4 to 2.3% (2). In the present study, one-third of the patients had diagnosed via mediastinoscopy with 100% diagnostic success rate.…”

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confidence: 44%

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Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis)

Kıter

Müsellim²,

Çetınkaya³

et al. 2011

Tuberk Toraks

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confidence: 44%

“…It has been intended generally for the noncaseating granulomatous inflammation proven by the biopsy. If the presentation is very characteristic like in Löfgren's syndrom, histopathological diagnosis might not be required (2).…”

Section: Clinical Presentations and Diagnostic Work-up In Sarcoidosismentioning

confidence: 99%

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis)

Kıter

Müsellim²,

Çetınkaya³

et al. 2011

Tuberk Toraks

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“…In particular, the risk of overlooking a malignant disease is feared among the physicians who manage sarcoidosis patients, although this risk is very small, at least in asymptomatic bilateral hilar adenopathy, on the condition that a careful observation is undertaken [25]. The diagnostic dilemma is excellently demonstrated by BOGAERTS et al [26].…”

Section: Discussionmentioning

confidence: 99%

Sarcoidosis and cancer revisited: a long-term follow-up study of 555 Danish sarcoidosis patients

Fk¹,

Hommelgaard²,

Schou³

1998

Eur Respir J

132

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For more than 20 yrs it has been debated whether the systemic disease sarcoidosis predisposes to malignant neoplasms. The aim of this study was to examine the occurrence of cancer in Danish sarcoidosis patients observed for 9-30 yrs. The clinical data of 555 consecutive sarcoidosis patients were linked with the nationwide Danish Cancer Registry in a database, comparing the results with the expected incidence in the Danish population, adjusted for sex, age and calendar time. The sarcoidosis patients were diagnosed in two areas during the periods of 1960-1971 and 1970-1981, respectively, and followed until December 31, 1991. No excess of cancer was observed in sarcoidosis patients. A total number of 48 patients were observed with cancer (20 males and 28 females). Cancer occurred 1-29 yrs after sarcoidosis diagnosis (median 14 yrs) The observed versus expected (O/E) ratio was 1.16 (95% confidence interval (CI) 0.75-1.79) in males and 1.28 (95% CI 0.88-1.86) in females. No increased occurrence of lung cancer or malignant lymphoma (O/E ratios 0.23, 95% CI 0.00-1.25 and 1.25, 95% CI 0.02-6.95, respectively) was found. Neither age at diagnosis of sarcoidosis nor clinical sarcoidosis features were indicators of later occurrence of malignancy. The study could not confirm previous reports of an increased occurrence of malignant neoplasms in Danish sarcoidosis patients.

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“…The traditional approach to confirming the diagnosis of sarcoidosis has presumed histology to be the gold standard and has not ideally fulfilled these conditions. 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].…”

Section: Introductionmentioning

confidence: 99%

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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Mediastinoscopy in Patients With Presumptive Stage I Sarcoidosis

Cited by 107 publications

References 34 publications

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis)

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis)

Sarcoidosis and cancer revisited: a long-term follow-up study of 555 Danish sarcoidosis patients

Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

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