PURPOSE: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Most patients demonstrate mediastinal lymphadenopathy. Endobronchial ultrasound guided transbronchial needle aspiration(EBUS-TBNA) is a minimally invasive technique that has a high diagnostic yield in the investigation of mediastinal disease including sarcoidosis lymphadenopathy. Some previous reports have discussed the echoic features of metastatic medistinal lymph nodes in lung cancer, however there has been no report about those of lymphadenopathy in sarcoidosis.
METHODS: We retrospectively analyzed echoic features of mediastinal lymph nodes obtained EBUS-TBNA performed in our institute. A total of 31 lymph nodes in 26 patients were evaluated. We categorized digital images of lymph nodes according to following categories;(1)shape(oval or round), (2)margin(distinct or indistinct), (3)ecogenecity (homogeneous or heterogeneous), (4)existence of germinal center structure(presence or absence). Objective measurments of echoic images were performed using Image J software. These echoic findings were compared with those of metastatic mediastinal lymph nodes in lung cancer.
RESULTS: In sarcoidosis lymph nodes, 67.7% had round shape,74.2% had distinct margin, and 96.8% had homogeneous ecogenecity. Germinal center structure was observed in 71.0%. In shape and margin, no significant defference could be observed between sarcoidosis and lung cancer metastasis. On the other hand, homogeneous echogenecity findings and presence of germinal center structure were more observed in sarcoidosis than lung cancer.
CONCLUSIONS: Homogeneous echogenecity and presence of germinal center might be distinctive echoic features of sarcoidosis lymphadenopathy via EBUS
CLINICAL IMPLICATIONS: Analysing the ecogenecity of medistinal lymph nodes help to distinguish sarcoidosis from lung cancer.
DISCLOSURE: The following authors have nothing to disclose: Naoyuki Imai, Kazuyoshi Imaizumi, Tomomi Ogawa, Ichidai Tanaka, Daisuke Aoyama, Yuichiro Shindo, Masahiro Morise, Izumi Hashimoto, Satoru Ito, Naozumi Hashimoto, Mitsuo Sato, Masashi Kondo, Yoshinori Hasegawa
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