Diffuse Lung Disease |

Addition of EBUS-TBNA to Bronchoscopic Biopsies in the Diagnosis of Sarcoidosis FREE TO VIEW

Ping Shi Zhu, MD; Thomas Vandemoortele, MD
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Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montreal, QC, Canada

Chest. 2015;148(4_MeetingAbstracts):401A. doi:10.1378/chest.2259841
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SESSION TITLE: Diffuse Lung Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: While the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported in providing sarcoidosis diagnosis, its performance in conjunction with other conventional bronchoscopic sampling methods remains to be clarified. We aimed to evaluate the sensitivity of different diagnostic modalities [EBUS-TBNA, transbronchial lung biopsy (TBLB), endobronchial biopsy (EBB)] performed during the same endoscopic procedure.

METHODS: We retrospectively reviewed the data of 27 cases of confirmed sarcoidosis that underwent an EBUS procedure between January 2013 and December 2014 in our center. Sensitivity of EBUS-TBNA, TBLB and EBB was evaluated in terms of yielding non-caseating granulomas.

RESULTS: Mean age of patients was 47 years old (range 30-71), with 16 males (59.3%). According to radiologic features, there were 14(51.9%) stage I and 13(48.1%) stage II. In 13(48.1%) cases, a prior non diagnostic bronchoscopy had been done before the EBUS. Pathological confirmation of sarcoidosis was established with EBUS procedure in 25(92.6%), the remaining 2 being diagnosed with subsequent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or thoracoscopy. Taken separately, TBNA yielded granulomas in 20(74.1%) patients, while EBB and TBLB provided diagnosis in 2(7.4%) and 14(51.9%) respectively. TBNA combined with TBLB gave a diagnostic yield of 92.6% (25/27). Flow cytometry on lymph node samplings was obtained in 22 cases. EBUS-TBNA was performed on a total of 77 lymph node stations (25 hilar and 52 mediastinal). Granulomas were found in 37(48.1%) of them. Core biopsy material with EBUS-TBNA was obtained in 16/77(20.8%), yielding diagnosis in 12 of these 16 samplings (75%). Performance of EBUS-TBNA was significantly optimized with the addition of core biopsy compared to cytology sampling alone (p<0.001). Yield of granulomas was greater with lymph node ≥10mm (52.5% vs 11.1%, p=0.02), while number of passes and lymph node stations did not show significant influence.

CONCLUSIONS: EBUS procedure with TBNA and TBLB proved to be an efficient tool for sarcoidosis diagnosis, while nearly one-half of our cohort underwent a prior non diagnostic standard bronchoscopy. Addition of core biopsy to cytology sampling enhanced the yield of granulomas from EBUS-TBNA.

CLINICAL IMPLICATIONS: EBUS with combined samplings should be considered as a first diagnostic procedure in sarcoidosis. Core biopsy material along with cytology specimens should be obtained from mediastino-hilar lymph nodes.

DISCLOSURE: The following authors have nothing to disclose: Ping Shi Zhu, Thomas Vandemoortele

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