PT  - JOURNAL ARTICLE
AU  - Devesh Dhasmana
AU  - Clare Bradley
AU  - David Connell
AU  - Peter George
AU  - Aran Singanayagam
AU  - Annette Jepson
AU  - Clare Craig
AU  - Corrina Wright
AU  - Phillip Molyneaux
AU  - Ajit Lalvani
AU  - Graham Cooke
AU  - Onn Min Kon
TI  - Improved and immediate diagnostics in mediastinal sarcoid lymphadenopathy via endobronchial ultrasound and quadruple testing
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - P3659
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/P3659.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/P3659.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - Background: Mediastinal lymphadenopathy carries a wide differential diagnosis, including sarcoidosis, Tuberculosis (TB) and malignancy. Endobronchial Ultrasound-guided Transbronchial Nodal Aspiration (EBUS-TBNA) allows safe access to these nodes.Methods: 119 patients with mediastinal lymphadenopathy were referred to our tertiary centre for EBUS-TBNA between January 2010 and August 2011. Final diagnoses were used to explore the utility of the 4 tests performed through EBUS-TBNA: immunology (IGRA and/or Tuberculin Skin Test); cytology; microscopy/culture; and the GeneXpert MTB/RIF integrated TB PCR assay.Results: 27 patients (23% of cohort) were diagnosed with sarcoidosis based upon consistent clinical features and supportive TBNA. Cytology was predominantly non-caseating granulomata (24/27 (89%); 3/27 reactive). Immunology was negative in 22/25 (88%), positive in 3/25, not tested in two patients. Sensitivity and specificity for sarcoidosis with immunology alone was 87% and 69%, respectively, with specificity improved by cytology to 91%. GeneXpert was negative in all six further cases otherwise inconclusive by combined immunology/cytology testing (reactive appearances (3), immunology positive (3) or not done (2)). Three patients failed empirical TB treatment and were later re-diagnosed as sarcoidosis; all were PCR-negative.Conclusions: Combined immunology/TBNA-cytology data provide good specificity for sarcoidosis in patients with mediastinal lymphadenopathy. The inclusion of negative GeneXpert MTB/RIF in our cohort provided support in diagnosis for an additional 29% of cases. Quad-testing provides a fast-track and accurate diagnosis of sarcoidosis over TB.