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Original Research: INTERVENTIONAL PULMONOLOGY |

A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis

Alain Tremblay, MDCM, FCCP; David R. Stather, MD, FCCP; Paul MacEachern, MD; Moosa Khalil, MBBCh; Stephen K. Field, MDCM, FCCP
Author and Funding Information

From the Division of Respiratory Medicine (Drs. Tremblay, Stather, MacEachern, and Field) and the Department of Pathology and Laboratory Medicine (Dr. Khalil), University of Calgary, Calgary, AB, Canada.

Alain Tremblay, MDCM, FCCP, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; e-mail: alain.tremblay@ucalgary.ca


The University of Calgary has received unrestricted educational grant support from Olympus Canada for support of continuing medical education courses on endobronchial ultrasonography, as well as for support of the interventional pulmonary medicine training program. Funding was received from the Jack Mackenzie Memorial Fund.

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

For editorial comment see page 327


© 2009 American College of Chest Physicians


Chest. 2009;136(2):340-346. doi:10.1378/chest.08-2768
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Background:  Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes has been found to be more accurate than standard TBNA in the setting of malignancy. In patients with suspected sarcoidosis, the smaller ultrasound needle may yield inadequate material to make a histologic diagnosis of granulomatous inflammation. The aim of this study was to compare the diagnostic yield of EBUS-guided TBNA to TBNA performed with a standard 19-gauge needle in patients with mediastinal adenopathy and a clinical suspicion of sarcoidosis.

Methods:  A randomized controlled trial was performed in a university medical center, enrolling 50 patients (of 61 screened, 2 declined, and 9 did not meet entry criteria) with hilar and/or mediastinal adenopathy and a clinical suspicion of sarcoidosis. Twenty-four patients were randomized to undergo EBUS-guided TBNA and 26 to undergo TBNA using a standard 19-gauge needle.

Results:  The primary outcome measure of diagnostic yield was 53.8% vs 83.3% in favor of the EBUS-guided TBNA group, an absolute increase of 29.5% (p < 0.05; 95% confidence interval [CI], 8.6 to 55.4%). After blinded research pathology review, diagnostic yield was 73.1% vs 95.8%, in favor of the EBUS-guided TBNA group, an absolute increase of 22.7% (p = 0.05; 95% CI, 1.9 to 42.2%). Sensitivity and specificity were 60.9% and 100%, respectively, in the standard TBNA group, and 83.3% and 100%, respectively, in the EBUS-guided TBNA group (absolute increase in sensitivity, 22.5%; p = 0.085; 95% CI, 3.2 to 44.9%).

Conclusions:  The diagnostic yield of EBUS-guided TBNA is superior to TBNA using a standard 19-gauge needle for sampling of mediastinal lymph nodes in patients with a clinical suspicion of sarcoidosis.

Trial registration:  ClinicalTrials.gov Identifier: NCT00373555

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