Abhishek Goyal1, Dheeraj Gupta, Ritesh Agarwal, Amanjit Bal, Raje Nijhawan, Ashutosh N Aggarwal. 1. *Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal Departments of †Pulmonary Medicine ‡Cytology §Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Abstract
BACKGROUND: The exact position of routine bronchoscopic sampling techniques in diagnostic workup of sarcoidosis is often debated. Herein, we ascertain the role of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB), and endobronchial biopsy (EBB) in diagnosis of sarcoidosis. METHODS: Consecutive patients with suspected sarcoidosis who underwent fiberoptic bronchoscopy were studied. TBLB, EBB, TBNA, or EBUS-TBNA was performed as indicated in a standardized manner. A diagnosis of sarcoidosis was established based on the finding of non-necrotizing granulomas or on clinical grounds at 6-month follow-up. Individual and cumulative yield of various procedures and their correlation with clinicoradiologic parameters was analyzed. RESULTS: Of the 164 patients studied, 151 were finally diagnosed as sarcoidosis. Granulomas were demonstrated in 127 (84.2%) patients. Diagnostic yield of TBLB, EBB, TBNA, and EBUS-TBNA was 68.7%, 49.6%, 22.43%, and 57.1%, respectively. Cumulative yields of various procedures were: EBB+TBLB 81.4%; TBLB+TBNA 73.7%; TBNA+EBB 62.9%; TBLB+EBB+TBNA 86.9%; and TBLB+EBB+EBUS-TBNA 86.4%. In those with visible mucosal abnormalities, TBLB+EBB conferred the highest diagnostic yield (92.8%). Clinical findings or radiologic stage had no impact on diagnostic yield. CONCLUSIONS: TBLB is an important tool in bronchoscopic diagnosis of sarcoidosis. If endobronchial abnormalities are seen during bronchoscopy, TBLB with EBB gives the best results otherwise TBLB combined with conventional TBNA and EBB or EBUS-TBNA are required to maximize the diagnostic yield.
BACKGROUND: The exact position of routine bronchoscopic sampling techniques in diagnostic workup of sarcoidosis is often debated. Herein, we ascertain the role of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB), and endobronchial biopsy (EBB) in diagnosis of sarcoidosis. METHODS: Consecutive patients with suspected sarcoidosis who underwent fiberoptic bronchoscopy were studied. TBLB, EBB, TBNA, or EBUS-TBNA was performed as indicated in a standardized manner. A diagnosis of sarcoidosis was established based on the finding of non-necrotizing granulomas or on clinical grounds at 6-month follow-up. Individual and cumulative yield of various procedures and their correlation with clinicoradiologic parameters was analyzed. RESULTS: Of the 164 patients studied, 151 were finally diagnosed as sarcoidosis. Granulomas were demonstrated in 127 (84.2%) patients. Diagnostic yield of TBLB, EBB, TBNA, and EBUS-TBNA was 68.7%, 49.6%, 22.43%, and 57.1%, respectively. Cumulative yields of various procedures were: EBB+TBLB 81.4%; TBLB+TBNA 73.7%; TBNA+EBB 62.9%; TBLB+EBB+TBNA 86.9%; and TBLB+EBB+EBUS-TBNA 86.4%. In those with visible mucosal abnormalities, TBLB+EBB conferred the highest diagnostic yield (92.8%). Clinical findings or radiologic stage had no impact on diagnostic yield. CONCLUSIONS:TBLB is an important tool in bronchoscopic diagnosis of sarcoidosis. If endobronchial abnormalities are seen during bronchoscopy, TBLB with EBB gives the best results otherwise TBLB combined with conventional TBNA and EBB or EBUS-TBNA are required to maximize the diagnostic yield.
Authors: Amrik S Ray; Changyi Li; Terrence E Murphy; Guoping Cai; Katy L B Araujo; Kyle Bramley; Erin M DeBiasi; Margaret A Pisani; Isabel Oliva Cortopassi; Jonathan T Puchalski Journal: Ann Thorac Surg Date: 2019-10-05 Impact factor: 5.102
Authors: Ioannis Vogiatzis; Maurizio Marvisi; Johan Coolen; Stefano Gasparini; Katerina M Antoniou; Bjorn Stallberg; Anders Bjerg; Felix J F Herth; Enrico Clini Journal: ERJ Open Res Date: 2015-05-15
Authors: Akash Verma; Kee San Goh; Chee Kiang Phua; Wen Yuan Sim; Kuan Sen Tee; Albert Y H Lim; Dessmon Y H Tai; Soon Keng Goh; Ai Ching Kor; Benjamin Ho; Sennen J W Lew; John Abisheganaden Journal: Medicine (Baltimore) Date: 2016-12 Impact factor: 1.889