The endosonography-guided needle aspiration in the diagnosis of sarcoidosis – randomized study

Kocoń, Piotr; Szlubowski, Artur; Kużdżał, Jarosław; Rudnicka-Sosin, Lucyna; Ćmiel, Adam; Soja, Jerzy; Włodarczyk, Janusz; Talar, Piotr; Smęder, Tomasz; Gil, Tomasz; Warmus, Janusz; Tomaszewska, Romana

doi:10.20452/pamw.3934

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…The diagnostic yield was higher for endoscopic ultrasound compared with EBUS, but this was not statistically significant. 100 These observations were further confirmed by a retrospective analysis. 101 The addition of a rapid on-site evaluation to EBUS-TBNA did not seem to increase the diagnostic yield, whereas a rapid on-site evaluation could greatly increase the diagnostic performance of cTBNA.…”

Section: Ultrasound Techniques In the Diagnosis Of Sarcoidosismentioning

confidence: 66%

Ultrasonography of the Mediastinum: Techniques, Current Practice, and Future Directions

et al. 2018

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In the everyday practice of respiratory physicians, ultrasound techniques play a key role by enabling several diagnostic and interventional procedures. The application of ultrasound to endoscopic procedures allows both a visualization and a guided sampling of mediastinal and hilar lymph nodes. Endobronchial ultrasound can be combined with transbronchial needle aspiration, and, similarly, endoscopic ultrasound can be combined with fine-needle aspiration to sample virtually all mediastinal nodal stations from the airways and the esophagus. Endobronchial ultrasound-transbronchial needle aspiration and endoscopic ultrasound-fine needle aspiration showed a complementary diagnostic yield, and, recently, endoscopic ultrasound with bronchoscope was introduced in clinical practice to perform a transesophageal needle aspiration by using an ultrasound bronchoscope. This technique allows a single operator to perform both transbronchial and transesophageal needle sampling with the same instrument during a single bronchoscopic procedure. Mediastinal staging impacts the management of patients affected by lung cancer, and the most recent guidelines clearly state that endobronchial ultrasound and endoscopic ultrasound should be the initial tissue sampling procedure over surgical staging. In addition, endoscopic ultrasound techniques demonstrated an excellent yield in diagnosing lymphoma and benign diseases, for example, sarcoidosis. The aim of this review was to discuss the current role and future perspectives of endosonography techniques available for the evaluation of the mediastinum. Special emphasis was placed on equipment and technical aspects, the diagnostic role, and future directions of development.

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Section: Ultrasound Techniques In the Diagnosis Of Sarcoidosismentioning

confidence: 66%

Ultrasonography of the Mediastinum: Techniques, Current Practice, and Future Directions

et al. 2018

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“…59 Data from direct comparisons between standard and endosonographic techniques in patients with sarcoidosis stage I/II documented an overall supremacy of the imaging-assisted procedures as single tool, in the absence of a significant difference between EBUS-TBNA and EUS-FNA, as recently suggested. 66,67 However, in a controlled trial randomizing patients to undergo c-TBNA or EBUS-TBNA, a similar diagnostic yield was found between c-TBNA combined with TBLB and EBB and EBUS-TBNA combined with TBLB, highlighting the importance of airways and lung parenchymal biopsies in improving the chance of detecting granulomas, although slightly increasing complication rates and time. 68 Moreover, this also implies that the conventional techniques can still be considered as valuable diagnostic tools, especially in centers with limited resources, where ultrasound-guided technology is not yet available.…”

Section: Diagnostic Workupmentioning

confidence: 89%

Pulmonary Sarcoidosis

Bonifazi

Gasparini

Alfieri

et al. 2017

Semin Respir Crit Care Med

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Sarcoidosis is a systemic granulomatous disorder of unknown etiology, with a predilection for the respiratory system, involved in more than 90% of cases, with considerable variability in terms of patterns and prognostic implications. A protean interplay between genetic susceptibility and antigen exposure in selected environmental contexts is likely to define not only the risk for disease but also the different clinical phenotypes. Advances in imaging and functional tests over the past decades have increasingly broadened the awareness of the wide spectrum of features potentially occurring in pulmonary sarcoidosis, while the evolution of diagnostic techniques in interventional pulmonology has increased the possibility of obtaining tissue characterization more easily, by means of ultrasound-guided tools and cryotechnology. However, histological proof is not always needed, as, in selected scenarios with compatible clinical and imaging picture, a confirmatory biopsy is perceived as redundant. The diagnostic workup should be tailored on a case-by-case basis, according to an integrated assessment of clinical features, local resources, and expertise availability. Owing to the heterogeneity of possible clinical scenarios and the paucity of evidence-based data on treatments, a standardized clinical management has yet to be established, and general approach usually reflects expert opinion from accumulated clinical data. Key elements of decision-making process are to assess the baseline severity of disease, to stratify the risk of progression, and to define the goals of treatment.

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“…In 2017, Kocon et al [62] published a prospective randomized study to assess the diagnostic yield of EBUS-TBNA and EUS-FNA, and to compare them with standard diagnostic techniques (such as EBB, TBLB and cTBNA). The authors stated that EUS-FNA had the highest diagnostic yield (75%) as a standalone test when compared with EBUS-TBNA (62%), but the combination of the two endosonographic techniques showed a diagnostic yield of 80%, whereas the combination of standard bronchoscopic procedures led to a diagnostic yield of 64%.…”

Section: Recent Bronchoscopic Techniquesmentioning

confidence: 99%

Role of Bronchoscopic Techniques in the Diagnosis of Thoracic Sarcoidosis

Pedro

Melo

Bastos

et al. 2019

JCM

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The diagnosis of sarcoidosis relies on clinical and radiological presentation, evidence of non-caseating granulomas in histopathology and exclusion of alternative causes of granulomatous inflammation. Currently, a proper diagnosis, with a high level of confidence, is considered as key to the appropriate diagnosis and management of the disease. In this sense, this review aims to provide a brief overview on the role of bronchoscopy in the diagnosis of thoracic sarcoidosis, incorporating newer techniques to establish, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), transesophageal ultrasound-guided needle aspiration with the use of an echo bronchoscope (EUS-B-FNA) and transbronchial lung cryobiopsy (TBLC). Most of the literature reports the diagnostic superiority of endosonographic techniques, such as EBUS-TBNA alone or in combination with EUS-FNA, over conventional bronchoscopic modalities in diagnosing Scadding stages I and II of the disease. Moreover, TBLC may be considered a useful and safe diagnostic tool for thoracic sarcoidosis, overcoming some limitations of transbronchial lung biopsy (TBLB), avoiding more invasive modalities and being complementary to endosonographic procedures such as EBUS-TBNA.

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The endosonography-guided needle aspiration in the diagnosis of sarcoidosis – randomized study

Cited by 5 publications

References 22 publications

Ultrasonography of the Mediastinum: Techniques, Current Practice, and Future Directions

Ultrasonography of the Mediastinum: Techniques, Current Practice, and Future Directions

Pulmonary Sarcoidosis

Role of Bronchoscopic Techniques in the Diagnosis of Thoracic Sarcoidosis

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