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Published online before print March 1, 2007, 10.1183/09031936.00028706
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Eur Respir J 2007; 29:1182-1186
Copyright ©ERS Journals Ltd 2007

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

M. Wong1,2,5, K. Yasufuku1,5, T. Nakajima3, F. J. F. Herth3, Y. Sekine1, K. Shibuya1, T. Iizasa1, K. Hiroshima4, W. K. Lam2 and T. Fujisawa1

Depts 1 of Thoracic Surgery, and 4 Basic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan. 2 Dept of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. 3 Dept of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany. 5 Both authors contributed equally to this manuscript and are considered first co-authors.

CORRESPONDENCE: T. Fujisawa, Dept of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Fax: 81 432262172. E-mail: fujisawat{at}faculty.chiba-u.jp

Keywords: Bronchoscopy, hilar lymphadenopathy, mediastinum, sarcoidosis, transbronchial needle aspiration, ultrasound

Received: February 2, 2006
Accepted February 15, 2007

A diagnosis of sarcoidosis should be substantiated by pathological means in order to thoroughly exclude other diseases. The role of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis has not been reported. The purpose of the present study is to evaluate the diagnostic yield of EBUS-TBNA in demonstrating the pathological features of sarcoidosis.

In total, 65 patients with suspected sarcoidosis, with enlarged hilar or mediastinal lymph nodes on computed tomography, were included in the study. Patients with a suspected or known malignancy or previously established diagnosis of sarcoidosis were excluded. Convex probe endobronchial ultrasonography integrated with a separate working channel was used for EBUS-TBNA. Surgical methods were performed in those in whom no granulomas were detected by EBUS-TBNA. Patients were followed up clinically.

EBUS-TBNA was performed on a total of 77 lymph node stations in 65 patients. A final diagnosis of sarcoidosis was made for 61 (93.8%) of the patients. The remaining four patients were diagnosed as having Wegener's granulomatosis (n = 1) or indefinite (n = 3). In patients with a final diagnosis of sarcoidosis, EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 56 (91.8%) of the patients. No complications were reported.

Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnoses of sarcoidosis.




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