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Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis

Depts of ¹ Pulmonary Medicine, and ² Pathology, Leiden University Medical Center, Leiden, The Netherlands

CORRESPONDENCE: J. T. Annema, Dept of Pulmonology C3-P, Albinusdreef 2, PO Box 9600, 2300 RC Leiden University Medical Center, Leiden, The Netherlands. Fax: 31 715262950. E-mail: j.t.annema@lumc.nl

Keywords: Endoscopic ultrasound-guided fine-needle aspiration, mediastinal lymph nodes, sarcoidosis

Received: August 24, 2004
Accepted November 6, 2004

The objective of the current study was to assess the yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for the diagnosis of sarcoidosis in a large patient group.

Bronchoscopy with transbronchial lung biopsy (TBLB) is nondiagnostic in 30% of patients with suspected sarcoidosis and has a risk of pneumothorax and haemoptysis. In order to obtain a diagnosis, mediastinoscopy is often performed as the next diagnostic procedure. EUS-FNA provides a nonsurgical alternative for the demonstration of noncaseating granulomas by aspirating mediastinal lymph nodes from the oesophagus.

In total, 51 patients with suspected sarcoidosis stage and underwent EUS-FNA. Thirty-six patients (71%) previously underwent a nondiagnostic bronchoscopy. All patients were clinically followed (median 18 months) and surgical–pathological verification occurred in those patients with EUS aspirates that contained unrepresentative material.

EUS-FNA demonstrated noncaseating granulomas without necrosis in 41 of 50 patients (82%) with the final diagnosis of sarcoidosis. Specific ultrasound features of clustered, well-demarcated iso-echoic lymph nodes were observed in 64% of patients with sarcoidosis. No complications occurred.

Endoscopic ultrasound-guided fine-needle aspiration has a high yield in diagnosing sarcoidosis and qualifies as the next diagnostic step after a nondiagnostic bronchoscopy. The current authors expect that endoscopic ultrasound-guided fine-needle aspiration will reduce the number of mediastinoscopies for the diagnosis of sarcoidosis dramatically.

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