Endobronchial ultrasound‐guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations

Abstract

Literaturesuggests that ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has excellent performance characteristics for diagnosis of sarcoidosis. However, many authors challenge the external validity of EBUS-TBNA results, as most studies were performed in referral centres by highly experienced investigators, and included populations with very high sarcoidosis prevalence.We performed a systematic review and meta-analysis to estimate the role of EBUS-TBNA for diagnosis of sarcoidosis in studies enrolling consecutive patients with lymphadenopathy detected at imaging studies, regardless of the suspected underlying clinical aetiology. The Pubmed, Embase, Cinahl, Web of Science and Cochrane Library databases were screened to identify the pertinent literature. Quality of eligible studies was assessed by Quality Assessment, Data Abstraction and Synthesis-2 criteria. Pooled diagnostic yield, sensitivity and specificity were calculated, and a summary receiver operating characteristic curve was constructed. Subgroup analysis was planned to identify possible sources of study heterogeneity. Fourteen studies, collectively involving 2097 patients, fulfilled eligibility criteria. The median prevalence of sarcoidosis was 15%. EBUS-TBNA had a pooled diagnostic yield of 0.79 (standard deviation, 0.24), a pooled sensitivity of 0.84 (95% confidence interval (CI), 0.79-0.88) and a pooled specificity of 1.00 (95% CI, 0.99-1.00). Only subgroup analysis exploring the influence of study design seemed to influence the observed inter-study heterogeneity for sensitivity, retrospective studies showing worst sensitivity than prospective ones. The results of EBUS-TBNA for diagnosis of sarcoidosis in clinically unselected populations are excellent and compare favourably with published results from studies conducted in selected populations. High-quality trials would be needed to evaluate factors possibly explaining the observed heterogeneity in sensitivity.

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

“…Practically, this is relevant when the nodal consistency precludes successful needle aspiration or an adequate cell block using the conventional EBUS‐TBNA technique, or inadequate material is obtained because of any reason. 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 .…”

“…Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) provides a high diagnostic yield, with a sensitivity of > 90% and specificity of 100% in lung cancer . In benign disease such as sarcoidosis, EBUS‐TBNA sensitivity is greater than 80%, with recent meta‐analyses showing a diagnostic yield from 54%‐93% with pooled diagnostic accuracy of 79% . Lymphoma diagnosis with EBUS‐TBNA can be challenging, ranging from 57%‐90% in various studies with an average of about 60% …”

“…[1][2][3][4][5] In benign disease such as sarcoidosis, EBUS-TBNA sensitivity is greater than 80%, 6 with recent meta-analyses showing a diagnostic yield from 54%-93% with pooled diagnostic accuracy of 79%. 7,8 Lymphoma diagnosis with EBUS-TBNA can be challenging, ranging from 57%-90% in various studies with an average of about 60%. [9][10][11] The 'expanded' aim of EBUS-guided mediastinal lymph node (MLN) sampling is to make an accurate diagnosis and obtain adequate material for targeted processing in both malignant and benign disease.…”

A Preclinical Evaluation Comparing the Performance of a Novel 19-G Flexible Needle to a Commercially Available 22-G EBUS-TBNA Sampling Needle

“…Diagnostic yield ranges from 54 to 93% with a pooled diagnostic accuracy of approximately 79%. Sensitivity of 0.80 (95% CI 0.74-0.95) has been reported in pulmonary sarcoidosis [20,21]. In lymphoma, EBUS-TBNAreported yield has also been lower with a wide range of sensitivities ranging between 31 and 91% [9].…”

Should endoscopic ultrasound‐guided biopsies for mediastinal abnormalities be performed by pediatric pulmonologists?

“…Metastatic lung disease, however, is rare in children, as is primary lung cancer. Yield and sensitivity are also good for other conditions, such as granulomatous disease (infectious and inflammatory, ie, sarcoidosis) . For the diagnosis of lymphoma, EBUS‐TBNA has not yet proven to have the same diagnostic utility in both the sensitivity of diagnosis and the ability to differentiate subtypes of lymphoma, due to the present inability to provide architecturally intact samples (future advances in the use of flow cytometry, needle design, and miniaturized forceps have the potential to improve upon this) …”