Pulmonary Procedures |

Value of Different Bronchoscopic Sampling Techniques in Diagnosis of Sarcoidosis: A Prospective Study of 151 Patients FREE TO VIEW

Dheeraj Gupta, DM; Abhishek Goyal, DM; Ritesh Agarwal, DM; Amanjit Bal, MD; Raje Nijhawan, MD; Ashutsoh Aggarwal, DM
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Postgraduate Institute of Medical Education and Research, Chandigarh, India

Chest. 2013;144(4_MeetingAbstracts):805A. doi:10.1378/chest.1700300
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Bronchoscopic procedures like transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB) are commonly used for demonstrating granulomatous inflammation in support of the diagnosis of sarcoidosis. We evaluated individual and additive diagnostic yield of these procedures.

METHODS: All consecutive patients who underwent fiberoptic bronchoscopy for suspected sarcoidosis between July 2011 and October 2012 were studied. TBLB, EBB, TBNA or EBUS TBNA was performed as indicated in a standardized fashion. A diagnosis of sarcoidosis was established based on finding non-necrotizing granulomas (after excluding fungus or mycobacteria) in tissue samples obtained during bronchoscopy. Patients with strong clinico- radiological picture and negative results on bronchoscopy were labeled as sarcoidosis if they had spontaneous resolution or response to corticosteroid treatment. Individual and cumulative yield of various procedures and their correlation with clinico-radiological parameters was analyzed.

RESULTS: Of the 164 patients studied, 151 (mean age 43.3 years, 79 men) were finally diagnosed as sarcoidosis. Granulomatous inflammation could be demonstrated in 127 (84.2%) patients, 19 had rapid response to steroids and 5 had spontaneous resolution. Diagnostic yield of TBLB, EBB, conventional TBNA and EBUS-TBNA was 68.7% (97/141), 49.6% (62/125), 22.43% (17/76) and 57.1% (16/28), respectively. Cumulative yields of various procedures were as follows: EBB+TBLB 81.4% (96/118); TBLB+TBNA 73.7% (70/95); TBNA+EBB 62.9% (56/89); TBLB+EBB+TBNA 86.9% (53/61) and TBLB+EBB+EBUS-TBNA 86.4% (19/22). Mucosal abnormalities were seen in 29 (19.2%) patients. In this group, TBLB+EBB conferred the highest diagnostic yield (92.8%) observed. Clinical findings or radiological stage had no impact on diagnostic yield.

CONCLUSIONS: Multiple sampling techniques improve the diagnostic yield of bronchoscopy in sarcoidosis. Best yield is achieved with a combination of TBLB, EBB and TBNA. Endobronchial abnormalities improve the diagnostic yield of EBB in sarcoidosis.

CLINICAL IMPLICATIONS: TBLB is an important tool in bronchoscopic diagnosis of sarcoidosis and should always be performed. If endobronchial abnormalities are seen during bronchoscopy, TBLB+EBB give the best results.

DISCLOSURE: The following authors have nothing to disclose: Dheeraj Gupta, Abhishek Goyal, Ritesh Agarwal, Amanjit Bal, Raje Nijhawan, Ashutsoh Aggarwal

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