Utility of Wang transbronchial needle biopsy in sarcoidosis.
Sarcoidosis is a multisystem granulomatous disease of unknown aetiology, commonly seen in the western world. The incidence varies and may be as high as 40/100,000 of the population per year. The commonest mode of presentation is as hilar and mediastinal lymphadenopathy on a chest radiograph. Even though sarcoid is in general a benign disease and most patients will not progress to chronic lung disease, a tissue diagnosis is necessary for management as other differential diagnoses such as lymphoma, tuberculosis and other causes of interstitial lung disease need to be excluded. The usual method of obtaining a tissue diagnosis is transbronchial forceps biopsy (TBBx), via a fibre-optic bronchoscope (FOB). The presence of non-caseating granuloma in the biopsy specimen is diagnostic of sarcoidosis if the tissue is stain and culture negative for tuberculosis and fungi. However TBBx carries significant complications-in particular there is a risk of pneumothorax (10-20 per cent) and significant and rarely life-threatening haemorrhage has been reported. Furthermore, a diagnosis of sarcoidosis is made by TBBx in only approximately 70 per cent of cases. Thus in about 30 per cent of cases a further procedure such as mediastinoscopy or open lung biopsy is required to obtain a tissue diagnosis. We report a patient with suspected sarcoidosis who had negative TBBx in whom the diagnosis was confirmed using a Wang transbronchial needle (MW-319, Mill Rose Lab., U.S.A.) to biopsy mediastinal lymph nodes via the FOB.
Leonard
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C
Department of Respiratory Medicine, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland.
Tormey
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V
Lennon
A
A
Burke
C M
CM
D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D012507:Sarcoidosis / Q000175:diagnosis / Q000473:pathology*; D012680:Sensitivity and Specificity