PURPOSE: Transbronchial needle aspiration (TBNA) is effective in the diagnosis of sarcoidosis, particularly when performed with a 19 gauge needle. Real-time endobronchial ultrasonography TBNA (EBUS) is effective in the diagnosis and staging of lung malignancy, but given its smaller 22 gauge needle, its role in the diagnosis of sarcoidosis is unclear. This study aims to compare TBNA vs. EBUS in patients with mediastinal adenopathy and a clinical suspicion of sarcoidosis.
METHODS: Randomized controlled trial. Subjects suspected of having sarcoidosis with mediastinal or hilar adenopathy (> 1 cm short axis on computed tomography) were randomized to TBNA vs. EBUS. Other samples were performed as deemed necessary by the bronchoscopist. On-site cytology was not used. The primary endpoint for this preliminary analysis was the presence of noncaseating granulomas (NCG) in the aspirate, on a per node basis.
RESULTS: Twenty-five patients of a planned enrollment of 50 have been randomized thus far (TBNA - 11, EBUS - 14) and 82 nodes sampled. Twenty patients had suspected Stage I (80%) and 5 patients Stage II (20%) sarcoidosis. The mean lymph node size (short axis) in the TBNA group and EBUS group was 18.1mm and 17.8mm respectively (p >0.05). The number of lymph node stations aspirated per patient in the TBNA vs. EBUS groups was 2.45 and 3.86 respectively (p < 0.001). NCG were demonstrated in 63.0% of the nodes aspirated in the TBNA group and 60.0% of the EBUS samples (p >0.05). Including all bronchoscopy samples, NCG were demonstrated in 23/25 patients (92%).
CONCLUSION: On a per node basis, EBUS-TBNA does not appear superior to standard 19g TBNA in the diagnosis of sarcoidosis, but facilitates aspiration of more lymph node stations per patient.
CLINICAL IMPLICATIONS: Bronchoscopic transbronchial needle aspiration of mediastinal nodes with or without EBUS is a useful test in diagnosing sarcoidosis. It has yet to be determined whether the addition of EBUS will improve the diagnostic rate of TBNA on a per patient basis.
DISCLOSURE: David Stather, No Financial Disclosure Information; No Product/Research Disclosure Information