Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis

Pauli, Georg; Pelletier, A; Böhner, C; Roeslin, N; Warter, A; Roegel, E

doi:10.1378/chest.85.4.482

Cited by 55 publications

(33 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…TBLB is the procedure of choice in most cases [1,2]. The yield of ,65% (range 40-90%) [3,4,[16][17][18][19] Transbronchial needle aspiration (TBNA) in patients with suspected sarcoidosis revealed noncaseating granulomas in 66% of patients using rigid [20] and 50-72% patients using flexible bronchoscopy [16,18,21]. The diagnostic yield of TBNA and TBLB combined is significantly higher than TBNA or TBLB alone [16,17,21], reaching up to 80-90% [16][17][18]21].…”

Section: Resultsmentioning

confidence: 99%

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

Annema

Veselic²,

Rabe³

2005

European Respiratory Journal

136

View full text Add to dashboard Cite

The objective of the current study was to assess the yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for the diagnosis of sarcoidosis in a large patient group.Bronchoscopy with transbronchial lung biopsy (TBLB) is nondiagnostic in 30% of patients with suspected sarcoidosis and has a risk of pneumothorax and haemoptysis. In order to obtain a diagnosis, mediastinoscopy is often performed as the next diagnostic procedure. EUS-FNA provides a nonsurgical alternative for the demonstration of noncaseating granulomas by aspirating mediastinal lymph nodes from the oesophagus.In total, 51 patients with suspected sarcoidosis stage I and II underwent EUS-FNA. Thirty-six patients (71%) previously underwent a nondiagnostic bronchoscopy. All patients were clinically followed (median 18 months) and surgical-pathological verification occurred in those patients with EUS aspirates that contained unrepresentative material.EUS-FNA demonstrated noncaseating granulomas without necrosis in 41 of 50 patients (82%) with the final diagnosis of sarcoidosis. Specific ultrasound features of clustered, well-demarcated iso-echoic lymph nodes were observed in 64% of patients with sarcoidosis. No complications occurred.Endoscopic ultrasound-guided fine-needle aspiration has a high yield in diagnosing sarcoidosis and qualifies as the next diagnostic step after a nondiagnostic bronchoscopy. The current authors expect that endoscopic ultrasound-guided fine-needle aspiration will reduce the number of mediastinoscopies for the diagnosis of sarcoidosis dramatically.

show abstract

Section: Resultsmentioning

confidence: 99%

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

Annema

Veselic²,

Rabe³

2005

European Respiratory Journal

136

View full text Add to dashboard Cite

show abstract

“…Tissue diagnosis using these areas is, therefore, reasonable, as they are a likely target for confirming the diagnosis, especially since TBLB yielded 30% of patients with undiagnosed suspected sarcoidosis [13]. The diagnostic yield of TBLB depends upon skill, number of biopsy samples taken and degree of interstitial involvement at the time of biopsy [14][15][16].…”

Section: Ebus-tbna In Sarcoidosis Diagnosismentioning

confidence: 99%

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

Wong¹,

Yasufuku²,

Nakajima³

et al. 2007

European Respiratory Journal

233

204

View full text Add to dashboard Cite

A diagnosis of sarcoidosis should be substantiated by pathological means in order to thoroughly exclude other diseases. The role of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis has not been reported. The purpose of the present study is to evaluate the diagnostic yield of EBUS-TBNA in demonstrating the pathological features of sarcoidosis.In total, 65 patients with suspected sarcoidosis, with enlarged hilar or mediastinal lymph nodes on computed tomography, were included in the study. Patients with a suspected or known malignancy or previously established diagnosis of sarcoidosis were excluded. Convex probe endobronchial ultrasonography integrated with a separate working channel was used for EBUS-TBNA. Surgical methods were performed in those in whom no granulomas were detected by EBUS-TBNA. Patients were followed up clinically.EBUS-TBNA was performed on a total of 77 lymph node stations in 65 patients. A final diagnosis of sarcoidosis was made for 61 (93.8%) of the patients. The remaining four patients were diagnosed as having Wegener's granulomatosis (n51) or indefinite (n53). In patients with a final diagnosis of sarcoidosis, EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 56 (91.8%) of the patients. No complications were reported.Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnoses of sarcoidosis.

show abstract

“…However, TBLB carries significant complications; in particular, there is a risk of pneumothorax (1-10%), and moderate (>25 mL) to severe (>100 mL) haemorrhage occurs in 5.4-0.6% of cases [8], although it is rarely life-threatening [1,8]. Furthermore, the diagnostic yield with TBLB in sarcoidosis ranges 40-90%, depending on the skill of the bronchoscopist, the number of biopsies taken, and degree of interstitial involvement at the time of biopsy [1,9,10]. Because of this variable yield from TBLB, alternative diagnostic modalities, such as mediastinoscopy or open lung biopsy, may be required to obtain a tissue diagnosis, with the associated risks and costs of a procedure requiring hospital admission and general anaesthesia.…”

mentioning

confidence: 99%

“…TBNA is a safe and effective method of obtaining cores of tissue for the histological diagnosis of benign and malignant disease in the mediastinal and hilar lymph nodes, and for staging malignant disease [9,10,[17][18][19][20][21][22][23][24]. Some authorities suggest that TBNA may become the procedure of choice for the diagnosis of stage I and II sarcoidosis [17,19].…”

mentioning

confidence: 99%

Bronchoscopic diagnosis of sarcoidosis

Leonard¹,

Tormey²,

O'Keane³

et al. 1997

Eur Respir J

View full text Add to dashboard Cite

Transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA) of mediastinal lymph nodes and bronchoalveolar lavage (BAL) are routinely performed at fibreoptic bronchoscopy. Up to the present time, no data have been available on the efficacy of performing all three of these procedures simultaneously in the bronchoscopic work-up of sarcoidosis. A prospective study was undertaken to compare the diagnostic yield from TBLB, TBNA and BAL in patients presenting with clinical and radiological features typical of sarcoidosis. Thirteen consecutive patients with clinical and radiological features consistent with stage I and II sarcoidosis underwent bronchoscopy with TBLB, TBNA and BAL. Noncaseating granulomata (stain and culture negative for tuberculosis bacilli and fungi) were found in seven of the 13 patients by TBLB, and in six of the 13 patients by TBNA (of which four patients had negative TBLB). Eight of the 13 patients had classical "sarcoid" BAL findings, i.e. >12% lymphocytes, and high CD4+:CD8+ lymphocyte ratio. Combining TBLB, TBNA and BAL gave a diagnostic sensitivity of 100% (12 out of 12 patients) for sarcoidosis. The remaining patient had nondiagnostic bronchoscopic studies and mediastinoscopy biopsy showed a non-Hodgkin's lymphoma. Our data suggest that performing simultaneous transbronchial lung biopsy, transbronchial needle aspiration and bronchoalveolar lavage produces optimal results in the diagnosis of sarcoidosis.

show abstract

Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis

Cited by 55 publications

References 7 publications

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

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

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

Bronchoscopic diagnosis of sarcoidosis

Contact Info

Product

Resources

About