Indications for Transbronchial Lung Biopsy in the Diagnosis of Intrathoracic Sarcoidosis

Abstract

80 patients in three different institutions underwent transbronchial lung biopsy (TBB) through a fiberoptic bronchoscope to confirm the diagnosis of sarcoidosis. A positive tissue diagnosis was obtained in 50 (75%) patients. The diagnostic yields in radiographic stage I, stage II and stage III sarcoidosis were 55% (12 of 22), 80% (33 of 41), and 82% (14 of 17), respectively. When the results in patients with stage I sarcoidosis were reviewed in conjunction with abnormalities on pulmonary function studies only reduced functional residual capacity (FRC) was found to be associated with increased diagnostic yield (80%) on TBB. We conclude that except for patients with radiographic stage I disease and normal FRC, TBB is the procedure of choice in patients with sarcoidosis when readily accessible extrathoracic abnormalities are not present.

British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE

“…One study demonstrated the sensitivity of TBLB to be 55% in stage I disease, 80% in stage II disease and 82% in stage III disease 162. In sarcoidosis, EBB may also prove useful, even without visible endobronchial abnormality, particularly when parenchymal disease exists 163.…”

Bronchoscopic sampling techniques in the era of technological bronchoscopy

“…92 Exceptions are conditions involving the centrilobular region (both at the terminal and respiratory bronchioles or along the lymphatic distribution, such as sarcoidosis, hypersensitivity pneumonitis, organizing pneumonia, eosinophilic pneumonias, and lymphangitic spread of malignancy). Sensitivity ranges from 55% in stage I to 80% in stage III 93 in sarcoidosis. Higher yield is found when biopsies are performed in >1 lobe and in the area of the most affected tissue in stage II/III disease.…”

High-resolution CT of diffuse interstitial lung disease: key findings in common disorders

“…On the other hand, if no granulomas are detected by transbronchial biopsy, the possibility of sarcoidosis cannot be excluded. The sensitivity of transbronchial biopsy is reported to be 80 % [21]. The second-line procedure would be a mediastinoscopy since most patients also have enlarged mediastinal lymph nodes.…”