Background: Sarcoidosis is a prevalent disease of
unknown cause characterized by granulomatous inflammation that often
creates deep and/or superficial mass lesions. Tissue samples are
considered the “gold standard” in diagnosis; however, it is a
medically treated disease. We analyzed the utility and relative
cost-effectiveness of fine-needle aspiration biopsy (FNAB) in the
clinical investigation of patients with both suspected and unsuspected
Methods: All FNAB cases with sarcoidosis
either as the cytologic diagnosis or mentioned as part of the
differential diagnosis were retrospectively reviewed for clinical
history, follow-up, cytologic features, and surgical pathology
findings. Comparative analysis of cost of FNAB and excisional biopsy
were also made.
Results: Thirty-two FNABs in 28
patients included 17 women and 11 men. Anatomic sites included lymph
node (n = 17), lung (n = 5), salivary gland (n = 8), and liver
(n = 2). Sarcoidosis had already been diagnosed or was a clinical
consideration prior to FNAB in 14 cases. Chest radiograph showed
abnormal findings in 19 cases. Angiotensin-converting enzyme (ACE) was
measured in seven patients and was elevated in four. All aspirates
showed granulomatous inflammation; in 22 patients, special stains or
cultures for microorganisms were negative. Simultaneous or subsequent
excisional biopsies confirmed the FNAB findings in 17 patients.
Institutional ratios of excisional biopsy to FNAB in the diagnosis of
sarcoidosis ranged from 4 to 19:1. The cost of FNAB was only 12.5 to
50% that of tissue biopsy.
Conclusions: FNAB appears
to be underutilized in the diagnosis of sarcoidosis. When used in
conjunction with radiologic and laboratory data, FNAB may be a reliable
and cost-effective method of diagnosis, especially in patients with an
established diagnosis of sarcoidosis.