title: Minimally invasive diagnosis of sarcoidosis by EBUS when conventional diagnostics fail.
abstract: BACKGROUND
  Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS) is a minimally invasive method used routinely for mediastinal staging of patients with lung cancer. EBUS has also proved to be a valuable diagnostic tool for patients with different intrathoracic lesions who remain undiagnosed despite bronchoscopy and CT-guided fine-needle aspiration.
  
  
  OBJECTIVE
  The present study focused on EBUS for diagnosing sarcoidosis.
  
  
  METHODS
  During a 3-year period 308 of 601 patients who underwent EBUS at our institution were referred for further diagnostic of a radiologically suspicious lesion in the lung parenchyma (n = 195), enlarged lymph nodes in the mediastinum (n = 89), a suspicious tumor in the mediastinum or pleural disease (n = 24) but no one had a definite histological diagnosis. All charts were reviewed retrospectively.
  
  
  RESULTS
  Of the 308 patients 43 (14%) were eventually diagnosed with sarcoidosis. Thirty-three (77%) were diagnosed with EBUS. In the remaining 10 patients EBUS did not provide adequate tissue samples in 4 (9%) and in 6 patients (14%) EBUS provided adequate tissue but no definite diagnosis. EBUS was significantly better to establish the diagnosis in patients with enlarged mediastinal lymph nodes compared with isolated lung parenchymal involvement (85% vs 63%, p < 0.05).
  
  
  CONCLUSIONS
  EBUS is a valuable minimally invasive diagnostic modality to establish the diagnosis of sarcoidosis of unselected patients with undiagnosed intrathoracic lesions after conventional work up--particularly if patients have enlarged mediastinal lymph nodes. This minimally invasive procedure provides a final diagnosis without exposing the patient to the risk of complications from more invasive procedures.
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark. jens@eckardtmail.dk
authors.forename: J
authors.initials: J
authors.lastname: Eckardt
authors.forename: K E
authors.initials: KE
authors.lastname: Olsen
authors.forename: O D
authors.initials: OD
authors.lastname: Jørgensen
authors.forename: P B
authors.initials: PB
authors.lastname: Licht
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001999:Bronchoscopy; D003718:Denmark; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed