Flexible Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis

doi:10.1378/chest.106.3.709

Chest

Volume 106, Issue 3, September 1994, Pages 709-711

https://doi.org/10.1378/chest.106.3.709 Get rights and content

The histopathologic diagnosis of sarcoidosis requires the presence of noncaseating granulomas. Transbronchoscopic lung biopsy (TBLB) has been considered the procedure of choice when less invasive tissue samples are unavailable. A total of 51 consecutive patients suspected of having sarcoidosis underwent combined TBLB and flexible transbronchial needle aspirate (TBNA). In 18 of the 30 patients (60 percent) with stage I disease, the diagnosis was confirmed by TBLB and 16 (53 percent) were confirmed by TBNA. The combined use of both procedures increased the diagnostic yield to 83 percent. The remaining 21 patients with stage II disease had their diagnosis confirmed in 16 (76 percent) cases by TBLB and 10 (48 percent) by TBNA with a combined diagnostic yield of 86 percent. Seven (23 percent) patients with stage I disease and 2 (10 percent) with stage II disease had their conditions diagnosed by TBNA. We conclude that combining TBNA with TBLB increases the diagnostic yield in pulmonary sarcoidosis; TBNA should complement TBLB in the diagnosis of this disease.

Section snippets

Material and Methods

Fifty-one patients diagnosed as having sarcoidosis by clinical and radiographic criteria as well as histologic evidence of noncaseating epithelioid cell granulomas were seen at Wilford Hall Medical Center between June 1989 and May 1993. All patients underwent flexible fiberoptic bronchoscopy with TBLB and TBNA. Patients were grouped according to their chest radiographs into stage I (hilar lymphadenopathy alone), 30 cases, and stage II (hilar lymphadenopathy with parenchymal infiltrates), 21

Results

Of the 30 patients with stage I disease, TBLB was positive in 18 (60 percent) and with stage II, 16 of 21 patients (76 percent). TBNA was positive in 16 of 30 patients (53 percent), and 10 of 21 patients (48 percent) with stage I and stage II, respectively. The combined use of both procedures increased the sensitivity to 25 of 30 patients (83 percent) in stage I, and 18 of 21 patients (86 percent) with stage II disease (Table 1).

The diagnostic rates for combined diagnostic procedures (TBLB,

Discussion

Transbronchial needle aspirate has been established as a useful diagnostic tool in multiple clinical settings, including peripheral pulmonary nodules, paratracheal masses, necrobiotic endobronchial lesions, and during mediastinal staging of lung cancer.10, 11, 12, 13, 14, 15, 16 Pauli et al¹⁷ reported an increase in the diagnostic yield of a total of 258 patients with suspected sarcoidosis by combining TBNA to TBLB using rigid bronchoscopy. In their study, patients with stage I and II disease

ACKNOWLEDGMENTS

We express our gratitude to Lawrence Epstein, M.D., for his suggestions and review of this manuscript, and to Rachel Montez for her expert manuscript preparation.

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These results were confirmed by other authors.57,58 Several authors support the use of TBNA in conjunction with TBLB in all patients with stage I and II sarcoidosis, since it markedly increases the diagnostic yield of bronchoscopy.59–61 The recent British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults recommend “conventional TBNA is a safe technique for sampling hilar and mediastinal lymph nodes in cases of suspected sarcoidosis and may be used in conjunction with endobronchial and transbronchial biopsies.54
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Fifty-two malignant nodes and 48 benign nodes were in the prediction set. Malignant nodes had a greater difference in the maximal and minimal pixel values, SEM pixel value, entropy, and correlation, and a lower energy (P < .0001 for all values). Fifty-one lymph nodes were in the validation set; 44 of 51 (86.3%) were classified correctly. Eighteen of these lymph nodes also had FDG-PET-CT scan assessment, which correctly classified 14 of 18 nodes (77.8%), compared with grey scale texture analysis, which correctly classified 16 of 18 nodes (88.9%).
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: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the US Government.

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Chest

Clinical Investigations: BiopsiesFlexible Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis

Section snippets

Material and Methods

Results

Discussion

ACKNOWLEDGMENTS

Transbronchial lung biopsy for the diagnosis of sarcoidosis.

N Engl J Med

Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis.

Ann Intern Med

Probability of a positive transbronchial lung biopsy result in sarcoidosis.

Arch Intern Med

Transbronchial lung biopsy through the fiberoptic bronchoscope in diagnosis of sarcoidosis.

BMJ

Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis.

Ann Otol Rhinol Laryngol

Transbronchial forceps lung biopsy through the fiberoptic bronchoscope.

Chest

Flexible transbronchial needle aspiration biopsy for histologic specimens.

Chest

Comparison of the Wang 19 gauge and 22 gauge needles for mediastinal staging of lung cancer as a cost effective alternative to surgery.

Am Rev Respir Dis

Clinical Investigations: Biopsies
Flexible Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis