title: The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis.
abstract: OBJECTIVE
  Transbronchial lung biopsy (TBLB) during flexible bronchoscopy (FB) is the recommended procedure for diagnosing sarcoidosis in most cases, although its yield in stage I disease is reported to be not as high as when parenchymal involvement is radiologically evident. We undertook this study to assess the diagnostic value of transbronchial needle aspiration (TBNA) in sarcoidosis presenting with hilar and/or mediastinal lymphadenopathy (stage I).
  
  
  METHODS
  Retrospective review of bronchoscopy procedures performed over a 6-year period for the diagnostic workup of hilar and/or mediastinal lymphadenopathy, as detected by chest radiographs.
  
  
  METHODS
  Urban academic hospital.
  
  
  METHODS
  Fifty-five patients with hilar and/or mediastinal lymphadenopathy without pulmonary abnormalities were included in the analysis.
  
  
  METHODS
  After chest CT and physical examinations, all patients underwent FB with TBNA. Patients thought to have clinicoradiologic findings highly consistent with sarcoidosis, as assessed by the bronchoscopists performing the procedures, underwent combined TBNA and TBLB.
  
  
  RESULTS
  A diagnosis of sarcoidosis was established in 32 patients. In the remaining 23 patients, other diseases were pathologically diagnosed. Overall, TBNA was diagnostic in 23 of 32 patients with sarcoidosis (72%) by showing nonnecrotizing granulomas in 28 of 39 lymph node stations sampled (72%). Among the 15 patients who were submitted to both TBNA and TBLB, TBNA exclusively established the diagnosis in 7 of 15 patients (47% increase in the diagnostic rate) and its yield exceeded that of TBLB (11 of 15 patients [73%] vs 6 of 15 patients [40%], respectively). The association of TBNA and TBLB increased the diagnostic yield to 87%.
  
  
  CONCLUSIONS
  TBNA may be of great value in the diagnostic evaluation of patients with suspected stage I sarcoidosis, and its use in association with TBLB should be strongly encouraged. TBNA may also preclude the need for further surgical diagnostic procedures in several patients with hilar and/or mediastinal adenopathy due to causes other than sarcoidosis.
authors.affiliation: Unit of Thoracic Endoscopy, Department of Pathology, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Trisolini
authors.forename: Luigi
authors.initials: L
authors.lastname: Lazzari Agli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cancellieri
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Baruzzi
authors.forename: Marco
authors.initials: M
authors.lastname: Patelli
mesh_terms: D001707:Biopsy, Needle; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis / Q000473:pathology*; D012680:Sensitivity and Specificity