Role of Bronchoscopic Techniques in the Diagnosis of Thoracic Sarcoidosis

Abstract

The diagnosis of sarcoidosis relies on clinical and radiological presentation, evidence of non-caseating granulomas in histopathology and exclusion of alternative causes of granulomatous inflammation. Currently, a proper diagnosis, with a high level of confidence, is considered as key to the appropriate diagnosis and management of the disease. In this sense, this review aims to provide a brief overview on the role of bronchoscopy in the diagnosis of thoracic sarcoidosis, incorporating newer techniques to establish, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), transesophageal ultrasound-guided needle aspiration with the use of an echo bronchoscope (EUS-B-FNA) and transbronchial lung cryobiopsy (TBLC). Most of the literature reports the diagnostic superiority of endosonographic techniques, such as EBUS-TBNA alone or in combination with EUS-FNA, over conventional bronchoscopic modalities in diagnosing Scadding stages I and II of the disease. Moreover, TBLC may be considered a useful and safe diagnostic tool for thoracic sarcoidosis, overcoming some limitations of transbronchial lung biopsy (TBLB), avoiding more invasive modalities and being complementary to endosonographic procedures such as EBUS-TBNA.

Usefulness of combined endobronchial and endoscopic ultrasound-guided needle aspiration in the diagnosis of sarcoidosis: a prospective, multicenter trial

“…Most of studies did not show clearly which cytological method, smear or CB, was used. 6,7,14, 16 Our data shows that CB preparation should be considered as the recommendation in the diagnostic workup of sarcoidosis.…”

“…Endosonography -guided biopsy techniques have higher efficacy than conventional methods (EBB and TBLB). 6,7,11, 16 The preferred method of obtaining cytological material is EBUS--TBNA. 17,18 Transesophageal approach seems The other limitation of the study protocol was the use of the same needle for the whole CUS--b-FNA procedure.…”

Imaging Methods for Pulmonary Sarcoidosis

“…Many studies assessing the possibility of using endoscopic ultrasonography in the evaluation of lymph nodes in patients suffering from sarcoidosis have been conducted in recent years. EBUS/EUS already enjoys an established position in the diagnosis of sarcoidosis [4][5][6]. EBUS allows to evaluate 2R, 4R lymph nodes on the right-hand side, 2L, 4L lymph nodes on the left-hand side, as well as paratracheal and subcarinal regions (group 7).…”

Current Diagnostic Techniques in Sarcoidosis

“…Transbronchial lung cryobiopsy is currently being increasingly considered as a diagnostic tool in ILD. The procedure requires general anesthesia and fluoroscopic Current Diagnostic Techniques in Sarcoidosis DOI: http://dx.doi.org/10.5772/intechopen.90692 guidance for sampling with a cryoprobe [32]. In a retrospective study by Jacob et al, they were able to demonstrate a diagnostic yield of up to 92.6% on a small sample size in the study [33].…”