title: Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis.
abstract: OBJECTIVE
  Several studies of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) have reported a sensitivity of approximately 90% in the diagnosis of mediastinal and hilar malignancies. However, few studies have addressed its role in the diagnosis of sarcoidosis. The aim of the present study was to assess the utility of EBUS-TBNA in confirming a pathological diagnosis of sarcoidosis.
  
  
  METHODS
  Fifteen consecutive patients with suspected sarcoidosis and mediastinal and/or hilar lymphadenopathy were investigated prospectively. EBUS-TBNA with an echo-bronchoscope and a dedicated echogenic 22-gauge needle was carried out in patients under conscious sedation, followed by conventional TBNA of the same lesion using a 19-gauge needle.
  
  
  RESULTS
  EBUS-TBNA and/or TBNA demonstrated non-caseating epithelioid cell granulomas in 14 of 15 patients (93%). All 14 patients with a pathological diagnosis of sarcoidosis were considered to have sarcoidosis based on subsequent clinical assessments. The single patient with a negative EBUS-TBNA and TBNA had a malignant melanoma diagnosed following surgical biopsy. EBUS-TBNA confirmed a diagnosis of sarcoidosis in 13 of the 14 patients (93%) by identifying non-caseating epithelioid cell granulomas in 18 of 23 lymph nodes (78%) sampled. When two needle aspirates of one or two lymph nodes were carried out, the percentage positive pathological diagnosis for sarcoidosis for (i) EBUS-TBNA; (ii) TBNA; and (iii) the combination of EBUS-TBNA and TBNA were 93% (13 of 14 patients), 93% (13 of 14 patients) and 100% (14 of 14 patients), respectively. There were no complications associated with the procedures.
  
  
  CONCLUSIONS
  EBUS-TBNA is less invasive and acceptably sensitive as a method for obtaining pathological confirmation of sarcoidosis.
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan. masahideo@aol.com
authors.forename: Masahide
authors.initials: M
authors.lastname: Oki
authors.forename: Hideo
authors.initials: H
authors.lastname: Saka
authors.forename: Chiyoe
authors.initials: C
authors.lastname: Kitagawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tanaka
authors.forename: Tomoya
authors.initials: T
authors.lastname: Shimokata
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kawata
authors.forename: Kouki
authors.initials: K
authors.lastname: Mori
authors.forename: Shigehisa
authors.initials: S
authors.lastname: Kajikawa
authors.forename: Shu
authors.initials: S
authors.lastname: Ichihara
authors.forename: Suzuko
authors.initials: S
authors.lastname: Moritani
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy; D015622:Epithelioid Cells / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted