Conventional Transbronchial Needle Aspiration Versus Endobronchial Ultrasound–guided Transbronchial Needle Aspiration, With or Without Rapid On-Site Evaluation, for the Diagnosis of Sarcoidosis: A Randomized Controlled Trial

Madan, Karan; Dhungana, Ashesh; Mohan, Anant; Hadda, Vijay; Jain, Deepali; Arava, Sudheer; Pandey, Ravindra M.; Khilnani, Gopi C; Guleria, Randeep

doi:10.1097/lbr.0000000000000339

Cited by 63 publications

(67 citation statements)

References 21 publications

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“…This technique is of greater significance in situations with benign aetiologies of mediastinal lymphadenopathy (such as TB and sarcoidosis) and lymphoma, which is known to have a lower yield on EBUS . However, when the suspected diagnosis is sarcoidosis, it is preferable to combine trans‐bronchial lung biopsy and endobronchial biopsy with EBUS‐TBNA, which may avert the need to do EBUS‐ TBFB . In our study, EBUS‐ROSE negative but EBUS‐TBFB positive included 6/8 patients with TB, 1/8 with invasive aspergillosis and 1/8 patients with lymphoma.…”

Section: Discussionmentioning

confidence: 86%

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Mehta

Aurangabadbadwalla

Singla

et al. 2019

Clinical Respiratory J

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Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) provides a high diagnostic yield in lung cancer, but the yield for benign conditions and lymphoma is lower. The material obtained by EBUS‐TBNA is limited by the lack of histopathological samples in some cases. The current ‘expanded’ aims of mediastinal lymph node (MLN) sampling are both an accurate diagnosis and adequate material for ‘targeted’ processing in malignant and benign disease. The sample obtained with the 21/22G EBUS needle may not be sufficient in all situations. Objectives The aim of the study was to evaluate the role of a novel technique for EBUS‐guided MLN forceps biopsy (EBUS‐TBFB) when EBUS‐TBNA with rapid on‐site‐evaluation (ROSE) failed to provide a diagnosis. In addition, the technical aspects and safety of EBUS‐TBFB were studied. Methods About 30 consecutive patients with enlarged MLN, with a negative EBUS‐TBNA ROSE were included. EBUS‐TBFB was done by the method described below. The histopathology and complications were recorded. Results Adequate samples for analysis were obtained in all the patients with both EBUS‐TBNA and EBUS‐TBFB. In patients with a non‐diagnostic EBUS‐ROSE, EBUS‐TBFB led to positive diagnostic results in an additional 8/30 patients (27%). Mild bleeding was noted in two patients who underwent EBUS‐TBFB, which resolved with conservative management. The procedure was safe with no major complications. Conclusion In patients with a negative EBUS‐ROSE, EBUS‐TBFB using this technique is safe and augments the diagnostic yield. EBUS‐TBFB adds to the armamentarium of EBUS, especially in benign aetiologies of MLN enlargement.

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Section: Discussionmentioning

confidence: 86%

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Mehta

Aurangabadbadwalla

Singla

et al. 2019

Clinical Respiratory J

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“…In the other study, there was no difference in the yield with sampling of either 1 or 2 lymph nodes [13]. Other studies in subjects with sarcoidosis have shown no difference in the yield with either the 21G or 22G needle or with the use of ROSE [8,9]. A small study of 11 subjects showed that the 19G conventional TBNA needle, when used with the EBUS scope, yielded tissue with better preservation of cellular architecture than that obtained with the 22G needle [12].…”

Section: Discussionmentioning

confidence: 97%

“…A few studies have analyzed various technical aspects of the EBUS-TBNA procedure in subjects with sarcoidosis (Table 3) [8,9,[11][12][13]. Two prospective observational studies have shown that the diagnostic yield increases for up to 4 or 5 total passes made [11,13].…”

Section: Discussionmentioning

confidence: 99%

“…The pooled yield of EBUS-TBNA in sarcoidosis is 79% (range, 54-93) [6]. When combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB), the yield may be as high as 92% [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…In this context, several factors such as the number of lymph nodes sampled, number of passes made, use of a larger bore (19G and 21G vs. 22G) aspiration needle, and the utilization of rapid onsite evaluation (ROSE) have been investigated [8,9,[11][12][13]. However, more research is required to delineate the utility of several other technical aspects of the procedure, and a call has been made for the same by 2 international societies [14,15].…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Trial Evaluating the Effect of 10 versus 20 Revolutions Inside the Lymph Node on the Diagnostic Yield of EBUS-TBNA in Subjects with Sarcoidosis

et al. 2018

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Background: Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is the preferred modality for sampling intrathoracic lymph nodes in patients with suspected sarcoidosis. Whether the number of revolutions of the needle inside the lymph node while performing TBNA affects the diagnostic yield is unknown. Objectives: The aim of this paper was to compare the yield of different numbers of needle revolutions (10 vs. 20) during EBUS-TBNA in sarcoidosis. Methods: Consecutive subjects with a clinicoradiological suspicion of sarcoidosis were randomized 1: 1 to undergo EBUS-TBNA with either 10 (group 1) or 20 revolutions (group 2). The primary and secondary outcomes were the diagnostic yield and adequacy of aspirates, respectively. Other outcomes were procedure duration, gross blood contamination of the aspirates, and safety of the procedure. Results: Of the 171 subjects screened, 150 (mean age 43.5 years; 47.3% women) were randomized. A mean of 2.8 (group 1: 2.8, group 2: 2.7; p = 0.37) lymph nodes were sampled per subject with a mean of 2.1 passes per node in each group (p = 0.60). Among 133 subjects finally diagnosed with sarcoidosis, there was no difference (p = 0.65) in the diagnostic yield of EBUS-TBNA between group 1 (52/65, 80.0%) and group 2 (57/68, 83.8%). Adequate aspirates were obtained in 96.9 and 97.1% of the subjects in groups 1 and 2, respectively (p = 1.00). There was no difference in the procedure duration, the proportion of subjects with grossly bloody specimens, or complications between the 2 groups. Conclusions: The diagnostic yield and specimen adequacy were not different when EBUS-TBNA was performed with 10 or 20 revolutions in subjects with sarcoidosis.

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Diagnosis and Treatment of Pulmonary Sarcoidosis

Belperio

Shaikh

Abtin

et al. 2022

JAMA

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ImportanceSarcoidosis is an inflammatory granulomatous disease of unknown cause that affects an estimated 2 to 160 people per 100 000 worldwide and can involve virtually any organ. Approximately 10% to 30% of patients with sarcoidosis develop progressive pulmonary disease.ObservationAmong patients with pulmonary sarcoidosis, the rate of spontaneous remission without serious sequelae ranges from 10% to 82%. However, lung disease progression occurs in more than 10% of patients and can result in fibrocystic architectural distortion of the lung, which is associated with a mortality rate of 12% to 18% within 5 years. Overall, the mortality rate for sarcoidosis is approximately 7% within a 5-year follow-up period. Worldwide, more than 60% of deaths from sarcoidosis are due to pulmonary involvement; however, more than 70% of deaths from sarcoidosis are due to cardiac involvement in Japan. Up to 70% of patients with advanced pulmonary sarcoidosis develop precapillary pulmonary hypertension, which is associated with a 5-year mortality rate of approximately 40%. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues. Although optimal doses of oral glucocorticoids for pulmonary sarcoidosis are unknown, oral prednisone typically starting at a dose of 20 mg/d to 40 mg/d for 2 to 6 weeks is recommended for patients who are symptomatic (cough, dyspnea, and chest pain) and have parenchymal infiltrates and abnormal pulmonary function test results. Oral glucocorticoids can be tapered over 6 to 18 months if symptoms, pulmonary function test results, and radiographs improve. Prolonged use of oral glucocorticoids may be required to control symptoms and stabilize disease. Patients without adequate improvement while receiving a dose of prednisone of 10 mg/d or greater or those with adverse effects due to glucocorticoids may be prescribed immunosuppressive agents, such as methotrexate, azathioprine, or an anti–tumor necrosis factor medication, either alone or with glucocorticoids combined with appropriate microbial prophylaxis for Pneumocystis jiroveci and herpes zoster. Effective treatments are not available for advanced fibrocystic pulmonary disease.Conclusions and RelevanceSarcoidosis has a mortality rate of approximately 7% within a 5-year follow-up period. More than 10% of patients with pulmonary sarcoidosis develop progressive disease and more than 60% of deaths are due to advanced pulmonary sarcoidosis. Oral glucocorticoids with or without another immunosuppressive agent are the first-line therapy for symptomatic patients with abnormal pulmonary function test results and lung infiltrates. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues.

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Conventional Transbronchial Needle Aspiration Versus Endobronchial Ultrasound–guided Transbronchial Needle Aspiration, With or Without Rapid On-Site Evaluation, for the Diagnosis of Sarcoidosis: A Randomized Controlled Trial

Abstract: When performing TBNA in the setting of suspected sarcoidosis, we found c-TBNA with ROSE and EBUS-TBNA (with or without ROSE) to be superior to c-TBNA alone. Whether c-TBNA with ROSE is equivalent to EBUS-TBNA cannot be determined from our study due to small sample size/low power.

Cited by 63 publications

References 21 publications

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

A Randomized Trial Evaluating the Effect of 10 versus 20 Revolutions Inside the Lymph Node on the Diagnostic Yield of EBUS-TBNA in Subjects with Sarcoidosis

Diagnosis and Treatment of Pulmonary Sarcoidosis

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