The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis

Abstract

A clinicoradiological presentation of thoracic sarcoidosis requires histopathology in order to establish the diagnosis. Flexible bronchoscopy has a reasonable diagnostic yield and is the procedure of first choice for diagnosis. Endoscopic ultrasound (endoscopic ultrasoundguided fine needle aspiration/endobronchial ultrasound-guided transbronchial needle aspiration) can help in the diagnosis of sarcoidosis.An implementation strategy of endoscopic ultrasound for the diagnosis of sarcoidosis following negative flexible bronchoscopy results was examined prospectively in 15 clinics.A total of 137 patients (92 males; median age 43 yrs) were included, and sarcoidosis was found in 115 (84%). Alternative diagnoses were tuberculosis, lymphangitis carcinomatosa, pneumoconiosis and alveolitis. All patients were sent for flexible bronchoscopy, which was performed in 121 (88%), resulting in a definite diagnosis in 57 (42%). A total of 80 patients were sent for endoscopic ultrasound, which could be performed in 72 (90%), yielding a definite diagnosis in 47 (59%). Endoscopic ultrasound following negative flexible bronchoscopy avoided a surgical procedure in 47 out of 80 patients. The sensitivity of flexible bronchoscopy for sarcoidosis was 45% (95% confidence interval 35-54%), but 62% (50-72%) if biopsy specimens were taken. The sensitivity of endoscopic ultrasound following negative flexible bronchoscopy results was 71% (58-82%). With this strategy, 97 out of 115 (84% (76-90%)) of proven sarcoidosis was diagnosed using endoscopy.This large prospective implementation study (trial number NCT00888212; ClinicalTrials.gov) shows that endoscopic ultrasound is valuable for diagnosing sarcoidosis after negative flexible bronchoscopy results.

Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

“…It therefore challenges recent literature that recommends that EBUS-TBNA should be combined with TBLB in patients with suspected sarcoidosis [10,13,17,19]. Some studies have used cytopathologists for EBUS-TBNA with ROSE [10,13,14] in patients with suspected sarcoidosis, but did not utilise the diagnostic information to enable a decision to be made not to proceed to TBLB.…”

“…The most plausible explanation for this discrepancy is that we undertook between eight and 10 biopsies in each patient in order to maximise diagnostic yield and each sample was only considered adequate if the diameter was o1-2 mm. Most other recent studies took only four to six biopsies [10,19,20,29] or failed to report the number of biopsies in each patient [17]. Four out of five of the patients had minimal, subclinical apical pneumothoraces which did not require chest tube drainage.…”

“…Single-centre studies have reported diagnostic yields of 83-94% and complication rates of ,1% [10,[13][14][15][16][17][18][19][20]. Recent studies concluded that EBUS-TBNA in combination with TBLB and other standard bronchoscopic techniques optimises the diagnostic yield and should be considered the first-line investigation in patients with suspected sarcoidosis [10,17,19]. Alternatively, the decision to proceed to TBLB after EBUS-TBNA was left up to the discretion of the bronchoscopist [13].…”

The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis

“…Today, with the introduction of real-time endobronchial ultrasound-guided TBNA (EBUS-TBNA) and transesophageal endoscopic ultrasound-guided fine needle aspiration, a higher number of patients is diagnosed with sarcoidosis [3][4][5]. Currently, endobronchial ultrasound (EBUS) is extensively used for mediastinal sampling; however, conventional bronchoscopic techniques are still the first choice in the diagnostic algorithm of sarcoidosis cases in many centers [1].…”

The Relationship Between Diagnostic Efficiency of Bronchoscopy with Clinical and Radiological Findings in Pulmonary Sarcoidosis

“…TBİA tanısallığı ile ilişkili olarak yapılan çalışmalarda endobronşiyal ultrasonografi (EBUS) eşliğinde alınan biyopsilerin tanı oranları daha yüksek bulunmuş olup, farklı çalış-malarda %60,9-90,3 arasında saptanmıştır. 9,[37][38][39][40][41][42] Bizim çalışmamızda TBİA tanısal verimliliği mevcut literatüre göre, biraz düşük (%46,4) olarak bulunmuştur. Bunun olası nedenleri; tüm hastalarda TBİA işleminin EBUS rehberliğinde yapılmamış olması ve her olgunun bu konuda uzman bir sitopatolog tarafından değerlendirilememiş olması ile açıklanabilir.…”