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Correspondence |

Endobronchial Ultrasonography vs Conventional Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis FREE TO VIEW

Gustavo Ferrer, MD; Rahul Khosla, MD
Author and Funding Information

From George Washington University, National VA Hospital.

Correspondence to: Gustavo Ferrer, MD, 2950 Cleveland Clinic Blvd, Weston, FL 33331; e-mail: gustavoferrermd@yahoo.com or ferrerg@ccf.org


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):235. doi:10.1378/chest.09-0895
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To the Editor:

We read with interest the recent article in CHEST (August 2009) by Dr Alain Tremblay and colleagues titled “A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis.”1 It was a well-designed study in terms of the pathologic analysis; however, in the “Methods” section, the authors did not describe the bronchoscopic techniques for conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA). There were more lymph node stations sampled with EBUS-TBNA than with the conventional TBNA. This we believe is a result of the study design, which left the decision regarding the site to sample at the discretion of the bronchoscopist. The diagnostic yield of conventional TBNA from specialized centers ranges from 72% to 90%,2-5 which is much higher than the 53.8% yield in this study. This difference can be explained by the fact that more lymph node stations were sampled per patient in other studies, and the majority of them included station 4R (right paratracheal) and station 7 (subcarinal). These lymph node stations are known to be enlarged in patients with stage I and II sarcoidosis. Many experts will agree with the notion that conventional TBNA, compared with EBUS-TBNA, is easier to perform in lymph node stations 4R and 7. A pathologist not specialized in the field of pulmonary pathology may find it difficult to analyze samples obtained via a 22-gauge EBUS-TBNA needle vs a 19-gauge conventional TBNA needle. This is because a diagnosis of sarcoidosis by histologic analysis is well standardized and easier to make, compared with cytopathologic analysis. Considering the low cost, availability, low complication rate, and ease of performance, conventional TBNA, in our opinion, should be considered the preferred technique in clinical practice.

Tremblay A, Stather DR, MacEachern P, et al. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest. 2009;1362:340-346. [CrossRef] [PubMed]
 
Wang KP, Fuenning C, Johns CJ, Terry PB. Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis. Ann Otol Rhinol Laryngol. 1989;984 Pt 1:298-300. [PubMed]
 
Trisolini R, Tinelli C, Cancellieri A, et al. Transbronchial needle aspiration in sarcoidosis: yield and predictors of a positive aspirate. J Thorac Cardiovasc Surg. 2008;1354:837-842. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology. 2007;126:863-868. [CrossRef] [PubMed]
 
Trisolini R, Agli LL, Cancellieri A, et al. The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis. Chest. 2003;1246:2126-2130. [CrossRef] [PubMed]
 

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References

Tremblay A, Stather DR, MacEachern P, et al. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest. 2009;1362:340-346. [CrossRef] [PubMed]
 
Wang KP, Fuenning C, Johns CJ, Terry PB. Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis. Ann Otol Rhinol Laryngol. 1989;984 Pt 1:298-300. [PubMed]
 
Trisolini R, Tinelli C, Cancellieri A, et al. Transbronchial needle aspiration in sarcoidosis: yield and predictors of a positive aspirate. J Thorac Cardiovasc Surg. 2008;1354:837-842. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology. 2007;126:863-868. [CrossRef] [PubMed]
 
Trisolini R, Agli LL, Cancellieri A, et al. The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis. Chest. 2003;1246:2126-2130. [CrossRef] [PubMed]
 
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