Endobronchial ultrasound‐guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the commonly used technique for pathological confirmation of clinically suspected sarcoidosis, mostly owing to its consistently high success rate in the detection of granulomas. However, other possible advantages, which are less appreciated and often poorly studied, may also contribute to the wider use of EBUS-TBNA in the future. These advantages include refinement of differential diagnoses through the study of lymph node characteristics during B-mode examination; reduction of complications associated with bronchoscopy, as well as improved triage of the specimen for ancillary studies with the use of rapid on-site evaluation; optimization of the quality of the sample through the selection of a target area for biopsy with minimal vascularity and absence of calcifications by using the colour Doppler and the B-mode; and prediction of the presence of extensive lymph node fibrosis by using the strain elastography module. Yet, limitations and possible clinical drawbacks should also be acknowledged. Indeed, due to the lack of specificity of the pathology findings in EBUSderived samples, the diagnosis of sarcoidosis is one of the exclusion and should remain essentially clinical. The external validity of EBUS-TBNA results in sarcoidosis is questionable, as they mainly derive from studies in populations with a high disease prevalence. Finally, the risk exists that the low morbidity and high diagnostic yield of EBUS-TBNA may lead to its overuse in patients with clinical/radiological findings specific enough to secure a clinical diagnosis of sarcoidosis.

Role of endobronchial ultrasound strain elastography in the identification of fibrotic lymph nodes in sarcoidosis: A pilot study

“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), increasingly used for the pathological confirmation of the clinical suspect of sarcoidosis, has a 20% failure rate in the detection of granulomas. [1][2][3][4] Clinical experience and anecdotal reports suggest that at least some of the non-diagnostic EBUS-TBNA in sarcoidosis may be caused by the presence of lymph nodes with extensive fibrosis. 2,5 We assessed the role of EBUS-strain elastography (EBUS-SE) in sarcoidosis patients enrolled in Nijmegen (The Netherlands) and Bologna (Italy) in the setting of the E-predict study.…”

“…[1][2][3][4] Clinical experience and anecdotal reports suggest that at least some of the non-diagnostic EBUS-TBNA in sarcoidosis may be caused by the presence of lymph nodes with extensive fibrosis. 2,5 We assessed the role of EBUS-strain elastography (EBUS-SE) in sarcoidosis patients enrolled in Nijmegen (The Netherlands) and Bologna (Italy) in the setting of the E-predict study. This was an international, multicentre prospective study aimed at assessing the reproducibility and the added clinical value of EBUS-SE in patients undergoing the procedure for mediastinal staging of lung cancer or suspected sarcoidosis (clinicaltrials.gov identifier: NCT02488928).…”

Pediatric Sarcoidosis: A Review with Emphasis on Early Onset and High-Risk Sarcoidosis and Diagnostic Challenges

“…Cytopathological assessments by fine needle aspiration provide fair diagnostic yield and excellent patient safety profile in children [37,38]. Combining EBUS and transbronchial needle aspiration (TBNA) lung biopsy and cytopathologic study may increase the diagnostic sensitivity to close to 100% [39,40]. On bronchoalveolar lavage (BAL) fluid with lymphocytosis (15%) and increased ratio of CD4 to CD8 (>3.5:1), the specificity for the diagnosis of sarcoidosis approaches 95% [36,41].…”

Clinical Characteristics of and Risk Factors for Fever after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Retrospective Study Involving 6336 Patients

“…EBUS-TBNA is mainly used for nodal staging in patients with suspected or established lung cancer [4]. The cumulative sensitivity of EBUS-TBNA in staging lymph nodes in patients with lung cancer ranged 85-100% [3,[5][6][7]. This technique has also been performed in patients with sarcoidosis, tuberculosis, and lymphoma, and lymphoma, and patients with unknown etiologic mediastinal lymphadenopathy [7][8][9][10].…”

“…The cumulative sensitivity of EBUS-TBNA in staging lymph nodes in patients with lung cancer ranged 85-100% [3,[5][6][7]. This technique has also been performed in patients with sarcoidosis, tuberculosis, and lymphoma, and lymphoma, and patients with unknown etiologic mediastinal lymphadenopathy [7][8][9][10]. Although complications associated with EBUS-TBNA are few, they do occur [3]; and as EBUS-TBNA use increases, significant and critical complications could increase also [1].…”