SESSION TITLE: EBUS Insights
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM
PURPOSE: Sarcoidosis remains a challenging diagnostic dilemma. Cervical mediastinoscopy (CMED) with lymph node sampling remains a gold standard for evaluation of suspected sarcoidosis. Endobronchial ultrasound with transbronchial needle biopsy (EBUS-TBNA) has shown promise for diagnosis in the setting of mediastinal adenopathy. Prior studies have shown EBUS-TBNA to have high yield in diagnosis of sarcoidosis, yet direct comparisons of EBUS-TBNA to mediastinoscopy have never been performed. Our aim was to compare EBUS-TBNA to mediastinoscopy for suspected sarcoidosis.
METHODS: We performed a retrospective chart review of all patients undergoing combined CMED and EBUS-TBNA as part of their usual care between November 2007 to December 2011 at Boston Medical Center. Only subjects undergoing evaluation for suspected sarcoidosis were included in the analysis. All subjects had lymph nodes sent for pathology and culture (bacterial, fungal, mycobacterial). A diagnosis of sarcoidosis was made if non-caseating granulomas were detected, cultures were finalized as negative, and no alternative diagnosis was made on follow up.
RESULTS: Of 61 subjects who underwent combined EBUS-TBNA and CMED, 19 subjects were ultimately diagnosed with early stage (stage I or II) sarcoidosis. EBUS-TBNA sampled a mean of 1.84 lymph node stations (range 1-3), while CMED sampled a mean of 1.79 lymph node stations (range 1-3). Granulomas were detected by CMED in all patients. EBUS-TBNA detected non-caseating granulomas in 17 of the 19 sarcoid subjects (sensitivity 89.5%). For five subjects in which only one lymph node station was sampled by EBUS-TBNA sensitivity was 60%, while the sensitivity for the remaining 14 subjects with more then one lymph node station sampled was 100%. The two subjects where granulomas were not detected by EBUS-TBNA had only one station sampled (both R-XI).
CONCLUSIONS: EBUS-TBNA may be used as an alternative to CMED for the diagnosis of sarcoidosis, providing at least two stations are sampled. Negative EBUS-TBNA may necessitate CMED.
CLINICAL IMPLICATIONS: EBUS-TBNA may be used as an alternative to CMED as long as two or more lymph node stations are sampled.
DISCLOSURE: The following authors have nothing to disclose: Yaron Gesthalter, Jeffrey Berman, Hiran Fernando, Michael Ebright
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