PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is emerging as an accurate and safe technique for the evaluation of suspected sarcoidosis. The role of on-site cytological evaluation of TBNA specimens for sarcoidosis remains poorly defined. We sought to evaluate the utility of EBUS-TBNA and specifically the role of on-site cytological evaluation in patients with suspected sarcoidosis.
METHODS: We performed a retrospective cohort study of consecutive patients from 01/08 to 06/10 with clinically suspected sarcoidosis who underwent EBUS-TBNA ± transbronchial biopsy (TBBx). The presence of non-necrotizing granulomas (NNG) and absence of an alternative pathologic finding was considered diagnostic of sarcoidosis. Patients without a definitive diagnosis by bronchoscopy (either sarcoidosis or an alternative diagnosis) were grouped into one of the following: 1) diagnosis of sarcoidosis based on surgical biopsy 2) clinical diagnosis of sarcoidosis 3) sarcoidosis unlikely. The overall yield of bronchoscopy, EBUS-TBNA, and the role of on-site cytology were determined.
RESULTS: A total of 62 patients with suspected sarcoidosis underwent bronchsocopy with EBUS-TBNA during the study period. A definite diagnosis by bronchoscopy was established in 49 patients (79%): 44 (71%) with sarcoidosis, and 5 (8%) with an alternative diagnosis (i.e. malignancy or mycobacterial disease). Of the remaining 13 patients in whom bronchoscopy was non-diagnostic: 1 was diagnosed with sarcoidosis by mediastinoscopy; 9 were deemed to have sarcoidosis based on clinical criteria; 3 were unlikely to have sarcoidosis. Thus, a total of 54 patients (of 62 total) were believed to have sarcoidosis. Of these 54 patients, EBUS-TBNA was diagnostic in 36 (67%). TBBx was performed in a total of 27 patients, and led to the diagnosis in an additional 8 patients in whom EBUS-TBNA was negative. Thus, the overall yield of bronchoscopy was 81% (44 of 54). On-site cytology was used in 32 patients, and was diagnostic for NNG in 8 (25%).
CONCLUSIONS: EBUS-TBNA and TBBx were effective and complimentary tools for establishing the diagnosis in patients with suspected sarcoidosis. On site cytological evaluation has limited utility in the evaluation of suspected sarcoidosis.
CLINICAL IMPLICATIONS: On-site cytological evaluation appears to have a limited role in patients with high suspicion of sarcoidosis. Further studies are needed to identify methods to increase the yield of on-site evaluation.
DISCLOSURE: The following authors have nothing to disclose: Akshatha Rao, Anthony Lanfranco, Colin Gillespie, Daniel Sterman, Andrew Haas, Anil Vachani
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