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Pulmonary Procedures |

Determinants of the Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) for the Diagnosis of Sarcoidosis

Asma Navasakulpong, MD; Manon Auger, MD; Anne Gonzalez, MD
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McGill University, Montreal, QC, Canada


Chest. 2013;144(4_MeetingAbstracts):818A. doi:10.1378/chest.1702484
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Abstract

SESSION TITLE: EBUS: New Approaches

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Recent studies have reported a high diagnostic yield of EBUS-TBNA for the diagnosis of sarcoidosis. The factors associated with successful demonstration of non-necrotizing granulomatous inflammation in EBUS-TBNA samples have not been clearly established. We sought to review the diagnostic yield of EBUS-TBNA for the diagnosis of sarcoidosis at our institution, and examine the factors that may influence this yield. We questioned the presence of a learning curve to the successful diagnosis of sarcoidosis using EBUS-TBNA.

METHODS: Patients who underwent EBUS-TBNA for suspected sarcoidosis were identified from a prospectively maintained list of all patients investigated with EBUS-TBNA between December 2008 and November 2011. EBUS was performed without rapid on-site evaluation (ROSE) of samples, using conventional cytologic preparations. Demographic and procedure-related data were retrospectively extracted. The final diagnosis was established based on the results of all invasive diagnostic procedures and/or clinical follow-up. Logistic regression analysis was used to examine the effect of procedure-related factors on diagnostic yield.

RESULTS: 43 patients underwent 45 EBUS-TBNA procedures for suspected sarcoidosis. A total of 115 lymph nodes were sampled. Both hilar and mediastinal nodes were sampled in a majority of procedures (87%). The 21G needle was used in 51% of procedures. The mean number of lymph node stations sampled was 2.6 (SD 0.7) and the mean number of needle passes per procedure was 7.8 (SD 2.0). Granulomatous inflammation was detected in EBUS-TBNA samples from 34/45 (76%) procedures. Needle gauge, number of lymph node stations sampled and number of needle passes were not associated with diagnostic yield. The yield of EBUS-TBNA significantly increased after the first 15 procedures performed for suspected sarcoidosis (47% for the first 15 procedures versus 90% thereafter, p<0.05).

CONCLUSIONS: EBUS-TBNA is a valuable tool for the diagnosis of sarcoidosis when performed without ROSE, using conventional cytologic preparations. The number of procedures performed has a significant impact on diagnostic yield.

CLINICAL IMPLICATIONS: There is a learning curve to the use of EBUS-TBNA for the diagnosis of sarcoidosis, with initial yields being lower than what is reported in the literature.

DISCLOSURE: The following authors have nothing to disclose: Asma Navasakulpong, Manon Auger, Anne Gonzalez

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