Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis.
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.
Annema
J T
JT
Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands. j.t.annema@lumc.nl
Veseliç
M
M
Rabe
K F
KF
D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011446:Prospective Studies; D012507:Sarcoidosis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity