Procedures: Procedures 2 |

Multicenter Prospective Study of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis: How Many Passes Are Adequate? FREE TO VIEW

Harunori Nakashima, MD; Masahide Oki, MD; Hideo Saka, MD; Tatsuo Kato, MD; Chiyoe Kitagawa, MD; Yoshihito Kogure, MD; Akira Shiraki, MD; Masahiko Ando, MD
Author and Funding Information

Ogaki Municipal Hospital, Ogaki, Japan

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1019A. doi:10.1016/j.chest.2016.08.1125
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SESSION TITLE: Procedures 2

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: While EBUS-TBNA is widely used as an initial diagnostic procedure for the pathological confirmation of sarcoidosis, it is unclear how many passes are required to obtain diagnostic materials. The purpose of the present study was to elucidate the number of needle passes needed for the diagnosis of stage I/II sarcoidosis.

METHODS: At 3 centers in Japan, one hundred and nine patients with suspected stage I/II sarcoidosis were recruited and underwent 6 passes of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the main target lesion. Additional EBUS-TBNA for lesions other than the main target lesion was performed according to the operator’s judgement. The cumulative yields of needle passes for detecting noncaseating epithelioid cell granuloma were analyzed.

RESULTS: A total of 109 patients underwent EBUS-TBNA for 184 lesions. EBUS-TBNA provided diagnostic materials in 91 patients (83%; noncaseating epithelioid cell granuloma in 82, others in 9 patients). Finally, ninety-three patients were given a diagnosis of sarcoidosis; thus, the sensitivity of EBUS-TBNA for pathological diagnosis of sarcoidosis was 88% (82 of 93 patients). In the 82 patients with noncaseating epithelioid cell granulomas, eighty-one patients were given diagnostic materials from the main target lesion through 6 passes, and the remaining patient was given diagnostic materials only from the second target lesion. The cumulative yields through the first, second, third, fourth, fifth and sixth passes for the main target lesion were 71, 84, 91, 95, 96 and 99%, respectively. In the 56 patients who underwent EBUS-TBNA for multiple lesions, the cumulative yield of 2 passes per lesion for 2 lesions (total 4 passes) and 4 passes for single lesion was 96% and 93%, respectively (p = 0.40). No complications were associated with the procedures.

CONCLUSIONS: If rapid on-site cytologic evaluation is not available, we recommend at least 4 passes per patient for either single or plural lesions with EBUS-TBNA for the pathological diagnosis of stage I/II sarcoidosis.

CLINICAL IMPLICATIONS: This study suggests that at least 4 passes with EBUS-TBNA are necessary to obtain satisfactory results for diagnosing stage I/II sarcoidosis.

DISCLOSURE: The following authors have nothing to disclose: Harunori Nakashima, Masahide Oki, Hideo Saka, Tatsuo Kato, Chiyoe Kitagawa, Yoshihito Kogure, Akira Shiraki, Masahiko Ando

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