Determining Factors in Diagnosing Pulmonary Sarcoidosis by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Sun, Jiayuan; Yang, Huizhen; Teng, Jinfang; Zhang, Jie; Zhao, Heng; Garfield, David H.; Han, Baohui

doi:10.1016/j.athoracsur.2014.09.029

Cited by 36 publications

(38 citation statements)

References 25 publications

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“…The diagnostic yield in specimens with 3 passes per lymph node nearly reached a plateau, while the diagnostic yield decreased with more than 5 passes per lymph node. The authors recommended EBUS-TBNA with 3–5 passes for the largest lymph node [21]. Different from our current study, the cumulative yield per lymph node was not analyzed in the study by Sun et al [21], as the number of needle passes per lymph node was not precisely defined.…”

Section: Discussionmentioning

confidence: 54%

“…Different from our current study, the cumulative yield per lymph node was not analyzed in the study by Sun et al [21], as the number of needle passes per lymph node was not precisely defined. A few investigators have suggested that the use of EBUS-TBNA for multiple lymph nodes rather than a single lymph node increases the diagnostic yield [6, 22], but this remains controversial [21, 23]. Our study indicated no difference in diagnostic yield between 1 and 2 lymph nodes.…”

Section: Discussionmentioning

confidence: 95%

“…Some investigators have assessed the number of passes or lymph nodes required as a secondary endpoint [5, 6, 21-23]. In an early study on the usefulness of EBUS- TBNA for diagnosing sarcoidosis, Garwood et al [5] reported a diagnostic yield of 85%, and the cumulative yield exceeded 80% at 5 passes.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, some studies on EBUS-TBNA for sarcoidosis used ROSE during the procedure [3, 5]. The limitation of ROSE is its limited availability; in many institutions, ROSE cannot be used because of manpower and cost issues [21]. …”

Section: Discussionmentioning

confidence: 99%

“…In addition, precise data on the number of needle passes performed per patient and lymph node were not available in their report. In a study to determine factors for diagnosing sarcoidosis by EBUS-TBNA, Sun et al [21] investigated the diagnostic yield per lymph node according to the number of passes. In their study, 111 patients had a final diagnosis of sarcoidosis, in whom EBUS-TBNA without ROSE was performed for 284 lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

et al. 2018

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Background: While endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used as an initial diagnostic procedure for pathological confirmation of sarcoidosis, it is unclear how many passes are required to obtain diagnostic materials. Objectives: The aim of this study was to determine the number of needle passes needed for the diagnosis of stage I/II sarcoidosis using EBUS-TBNA. Methods: At three institutions, 109 patients with suspected stage I/II sarcoidosis were recruited and underwent 6 passes of EBUS-TBNA for the main target lesion. Additional EBUS-TBNA for other lesions was permitted. The cumulative yields of needle passes for detecting noncaseating epithelioid cell granulomas were analyzed. Results: A total of 109 patients underwent EBUS-TBNA for 184 lesions. EBUS-TBNA identified specimens containing granulomas in 81 of 92 patients (88%) with a final diagnosis of sarcoidosis. The cumulative yields through the first, second, third, fourth, fifth, and sixth passes for the main target lesion were 63, 75, 82, 85, 86 and 88%, respectively. In the 55 patients that underwent EBUS-TBNA for multiple lesions, the cumulative yields of 2 passes per lesion for 2 lesions (total of 4 passes) and of 4 passes for single lesions were 86 and 84%, respectively (p = 1.00). Conclusions: If rapid on-site cytological evaluation is not available, we recommend at least 4 passes per patient for either single or multiple lesions with EBUS-TBNA for pathological diagnosis of stage I/II sarcoidosis.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

et al. 2018

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Sarkoidose und Uveitis

Garweg

2016

Ophthalmologe

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Ocular involvement in sarcoidosis is present in up to one third of patients and is frequently manifested before the underlying systemic disease has been diagnosed. With a view to the therapeutic consequences an early diagnosis of the underlying disease is advantageous. In cases of visual loss early diagnostic measures include invasive procedures, such as ultrasound-guided bronchoalveolar lavage and transbronchial biopsy, if nodular conjunctival or cutaneous manifestations which would confirm the diagnosis are not present. Sufficiently sensitive biomarkers of disease activity have not yet been identified. As elevated activity of angiotensin-converting enzyme (ACE) and lysozyme are associated with disease activity they may be supportive of but not specific for the diagnosis. Other indicators include calcemia, calciuria, augmented activity of hepatic enzymes, cutaneous anergy and hilar changes in the lungs. In patients with newly diagnosed anterior uveitis presenting with granulomatous mutton-fat corneal precipitates, snow balls and vitreous body base condensates with mild retinal periphlebitis in intermediate uveitis as well as multifocal choroiditis (creamy choroidal lesions at different stages of activity and approximately 500 µm in diameter), a diagnosis of sarcoidosis has to be considered and tuberculosis should be excluded, even in the absence of a known systemic disease. Anterior uveitis is frequently a self-limiting condition, which can be well-controlled with topical steroids. On the other hand, intermediate, posterior and panuveitis are typically associated with a chronic course and require systemic therapy to prevent severe loss of vision. If the response to systemic corticosteroids is insufficient, treatment with immunomodulatory agents and biologics is initiated at progressively earlier stages, with a view to averting permanent organ damage and frequently with a positive impact on the short and long-term outcomes, even in therapy-refractive cases.

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Bronchoscopic Modalities to Diagnose Sarcoidosis

Benzaquen¹,

Aragaki²

2019

Sarcoidosis

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Determining Factors in Diagnosing Pulmonary Sarcoidosis by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Cited by 36 publications

References 25 publications

How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

Sarkoidose und Uveitis

Bronchoscopic Modalities to Diagnose Sarcoidosis

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