Application of rigid bronchoscopy with endoscopic bronchial ultrasound-guided transbronchial node biopsy in pulmonary sarcoidosis

Abstract

Background Pathological examination of diseased lymph nodes is crucial for diagnosing pulmonary sarcoidosis, and obtaining quality histological specimens is important for improving the diagnosis rate. This study assessed the diagnostic rate and safety differences associated with performing endobronchial ultrasound-guided transbronchial node biopsy plus rapid on-site evaluation versus traditional endobronchial ultrasound-guided transbronchial needle aspiration plus rapid on-site evaluation for pulmonary sarcoidosis. Methods This retrospective study included data from 110 patients diagnosed with pulmonary sarcoidosis after undergoing rigid bronchoscopy combined with endobronchial ultrasound to obtain hilar or mediastinal lymph node specimens between March 2016 and May 2022. A rapid on-site evaluation was used to evaluate all intraoperative samples. Results Diagnostic rates of pulmonary sarcoidosis via endobronchial ultrasound-guided transbronchial node biopsy and endobronchial ultrasound-guided transbronchial needle aspiration were 94.0% (63/64) and 72.1% (31/43; relative risk = 1.30, 95% confidence interval: 1.07–1.59; P = 0.002), respectively. Regarding intraoperative safety, four (9%) patients in the endobronchial ultrasound-guided transbronchial needle aspiration group and five (7%) patients in the endobronchial ultrasound-guided transbronchial node biopsy group had intraoperative airway bleeding without intervention (relative risk = 1.02, 95% confidence interval: 0.91–1.15; P = 0.74). There were no other between-group differences in postoperative adverse effects. Conclusions Compared with traditional endobronchial ultrasound-guided transbronchial needle aspiration combined with rapid on-site evaluation, endobronchial ultrasound-guided transbronchial node biopsy combined with rapid on-site evaluation is of increased diagnostic value when assessing mediastinal or hilar lymphadenopathy suspected to be pulmonary sarcoidosis. Further, no significant differences in intra- or postoperative complications and adverse reactions were observed.