To determine the utility, sensitivity and complication rate of CT-guided transthoracic needle aspiration and core biopsy for sampling enlarged hilar and mediastinal lymph nodes in patients with presumptive sarcoidosis.
A retrospective review of all transthoracic needle biopsies performed at one institution from 1995-present for diagnosis of enlarged hilar or mediastinal lymph nodes thought to reflect sarcoidosis and either 1) symptoms requiring definitive diagnosis for treatment or 2) a history of malignancy where metastatic disease was a differential diagnostic consideration.
28 patients, age range 34-74, males = 13, females = 15, underwent CT-guided aspiration (n=28) and core (n=19) biopsy using an extrapleural approach when possible. 9 patients had a history of prior or concurrent malignancy. Using a combination or cytologic and histologic material, a diagnosis of sarcoidosis and exclusion of malignancy was possible in all patients (sensitivity = 100%). 8/28 patients (28%) developed a postbiopsy pneumothorax, with 2 (7%) requiring small bore catheter drainage and one patient with self-limited hemoptysis.
CT-guided transthoracic needle biopsy, using a combination of aspiration and core biopsy techniques, has a high yield and acceptable complication rate for the diagnosis of sarcoidosis presenting with enlarged mediastinal and hilar lymph nodes.
This minimally-invasive technique can provide definitive pathologic diagnosis of sarcoidosis in patients with enlarged mediastinal and hilar lymph nodes, confidently excluding malignancy and obviating the need for further invasive diagnostic procedures.
Alisa Johnson, None.