PURPOSE: Pulmonary sarcoidosis is an inflammatory disease often involving lung parenchyma and mediastinal lymph nodes. Current guidelines recommend a clinical, radiologic and pathologic approach for its diagnosis. Endobronchial ultrasound (EBUS) fine-needle aspiration (FNA) is increasingly used to obtain tissue for diagnosis and commonly reveals the presence of non specific granulomatous lymphadenitis, non caseating granulomas or epitheloid cells. We assessed the diagnostic accuracy of these cytologic findings on EBUS FNA samples in patients referred for the evaluation of sarcoidosis.
METHODS: We retrospectively reviewed all EBUS FNA specimens obtained in patients with clinical suspicion of sarcoidosis from January 2007 to April 2011 (Olympus BF-180). All specimens were evaluated by a board certified cytopathologist and special stains where used to rule out mycobacterial and fungal infections. Flow cytometry was performed when lymphoma was suspected. Final clinical diagnosis (FCD) was obtained after 6 to 12 months of clinical follow-up by evaluating symptoms, response to therapy, radiography, microbiology and other pathology specimens when available.
RESULTS: A total of 49 consecutive patients underwent EBUS FNA for the diagnosis of sarcoidosis. The average age was 45.6 years old (SD +/- 10.6) with 55% women. 87.8% of patients had radiographic stage I or II, with cough and dyspnea being the most commonly reported symptoms (50% and 34% respectively). Cytopathology features suggestive of sarcoidosis were found in 39 of the patients, leading to an overall sensitivity and specificity of 86% and 100%, respectively. Cytopatholology descriptions included granulomatous lymphadenitis in 14 cases (36%), non caseating granulomas in 23 cases (59%) and epitheloid cells in 2 cases (5%). Overall, 100% of patients had an FCD of pulmonary sarcoidosis with no other alternative diagnosis on follow up.
CONCLUSIONS: In patients with clinical features of pulmonary sarcoidosis, EBUS FNA has a high diagnostic yield. Granulomatous lymphadenitis, non caseating granulomas and epitheloid cells obtained with this modality are all equally supportive of the diagnosis.
CLINICAL IMPLICATIONS: This data suggests that mediastinal EBUS FNA offers diagnostic accuracy in patients with clinical suspicion of pulmonary sarcoidosis.
DISCLOSURE: The following authors have nothing to disclose: Veronica Palmero, Tal Klatchko, Huma Aslam, Pierre Kory, Samuel Acquah
No Product/Research Disclosure Information