Diffuse Lung Disease |

Diagnostic Yield of EBUS-TBNA in Sarcoidosis FREE TO VIEW

Faizan Shaikh, MBBS; Kyle Brownback; Lewis Satterwhite; Lucas Pitts; Franklin Quijano
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Internal Medicine, Kansas University Medical Center, Overland Park, KS

Chest. 2014;146(4_MeetingAbstracts):361A. doi:10.1378/chest.1987618
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SESSION TITLE: Interstitial Lung Disease Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively safe and minimally invasive procedure that is used frequently to investigate mediastinal lymphadenopathy. Mediastinal lymphadenopathy is a classic finding in sarcoidosis which can be effectively sampled with EBUS-TBNA. Diagnostic yield for EBUS-TBNA in sarcoidosis approaches 90% in some studies obviating the need for mediastinoscopy which remains the gold standard for diagnosis. Due to its safety in comparison to mediastinoscopy, EBUS-FNA can be used as a first-line for approaching medistinal lymphadenopathy in suspected sarcoidosis. In this study, we have evaluated the usefulness of EBUS-TBNA in sarcoidosis.

METHODS: A retrospective review was performed of all patients who underwent EBUS-TBNA for presumed sarcoidosis from Jan 2011 to Nov 2013. 25 patients were included in the study and parameters such as nodal station, stage, alternative method of diagnosis and symptoms were recorded.

RESULTS: Of 25 patients who qualified for analysis, 18 (72%) were men and 7 (28%) were women with an average age of 54.5. Symptoms included cough (36%), dyspnea (40%), extrapulmonary symptoms (16%) and all patients had mediastinal lymphadenopathy. Most patient had presumed stage I disease (44%) followed by stage II (36%) and stage IV (4%). 1 patient had an unknown stage. 13 out of 25 patients had non-caseating granulomas on EBUS with a diagnostic yield of 52%. 42 total stations were sampled which included 2r, 4r, 4l, 7, 10r, 11r, and 11l with diagnostic yield of 0%, 67%, 100%, 58%, 0%, 22% and 33%, respectively. Of the 12 patients not diagnosed at EBUS, diagnosis was made in 4 (33%) with transbronchial biopsy, 2 (17%) with medisatinoscopy, 1 (8%) with VATS, 4 (33%) with CD4:CD8 ratio and response to therapy, and 1 (8%) with muscle biopsy. Average CD4:CD8 ratio from lymph node aspiration was 5.4 for all patients. In patients who were diagnosed on EBUS, CD4:CD8 ratio was 4.

CONCLUSIONS: EBUS-TBNA is a useful and minimally invasive tool for diagnosis of sarcoidosis. It could be used as a first step in diagnosis of sarcoidosis if mediastinal LAD is present. CD4:CD8 ratio could also be used to assist diagnosis in presence of high clinical suspicion.

CLINICAL IMPLICATIONS: EBUS-TBNA may be used as a first-line diagnostic test in presumed sarcoidosis with associated medistinal LAD.

DISCLOSURE: The following authors have nothing to disclose: Faizan Shaikh, Kyle Brownback, Lewis Satterwhite, Lucas Pitts, Franklin Quijano

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