Chest
Volume 124, Issue 6, December 2003, Pages 2126-2130
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Clinical Investigations
SARCOIDOSIS
The Value of Flexible Transbronchial Needle Aspiration in the Diagnosis of Stage I Sarcoidosis

https://doi.org/10.1378/chest.124.6.2126Get rights and content

Study objectives

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).

Design

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.

Setting

Urban academic hospital.

Patients

Fifty-five patients with hilar and/or mediastinal lymphadenopathy without pulmonary abnormalities were included in the analysis.

Interventions

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.

Section snippets

Study Design

To assess the diagnostic yield of TBNA in the setting of stage I sarcoidosis, we retrospectively reviewed the records of the bronchoscopic procedures performed between January 1997 and December 2002 in the evaluation of hilar and/or mediastinal lymphadenopathy without pulmonary abnormalities, as detected by chest radiographs. All procedures were performed at a single institution (Unit of Thoracic Endoscopy, Maggiore Hospital, Bologna).

Bronchoscopic Procedures

After chest CT and physical examination, all patients

Results

Of the 55 patients enrolled in the study, 23 patients were pathologically proven to have diseases other than sarcoidosis, namely metastatic cancer (n = 10), lymphoproliferative disorder (n = 10), mycobacterial infection (n = 2), and lymphadenopathy in the setting of heart failure (n = 1).14 TBNA proved diagnostic in 8 of 10 cases of metastatic cancer (80%; 95% CI, 44 to 97%), in 6 of 10 cases of lymphoproliferative disorder (60%; 95% CI, 22 to 88%), and in the 3 cases of nonneoplastic disease.

Discussion

In the last 2 decades, a growing amount of data have appeared in the literature suggesting that TBNA is a safe, effective, and cost-saving method in the diagnosis and mediastinal staging of lung cancer.1315161718 Far less information is available on the role of TBNA in the setting of sarcoidosis, and the technique is not even mentioned as a diagnostic tool in the recently published American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous

References (21)

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