Transesophageal Bronchoscopic Ultrasound-Guided Fine Needle Aspiration for Diagnosis of Sarcoidosis

Abstract

Background: Several studies have reported that specimens from mediastinal lesions located adjacent to the esophagus can be sampled using an ultrasound bronchoscope instead of an ultrasound endoscope. Objectives: The aim of this study was to evaluate the diagnostic utility of transesophageal bronchoscopic ultrasound-guided fine needle aspiration using an ultrasound bronchoscope in patients with stage I/II sarcoidosis. Methods: Thirty-three patients suspected of having stage I/II sarcoidosis were included in this prospective study. Needle aspiration through the esophagus using an ultrasound bronchoscope was performed for hilar and/or mediastinal lymph nodes. The final diagnosis of sarcoidosis was based on clinicoradiological compatibility and pathological findings. Results: A total of 62 lymph nodes with a mean shortest diameter of 13.6 mm were examined. Of the 33 patients enrolled, 29 were given a final diagnosis of sarcoidosis. Four of the residual patients had other diseases (1 lung cancer, 1 tuberculosis, 2 non-specific lymphadenitis). Transesophageal bronchoscopic ultrasound-guided fine needle aspiration showed noncaseating epithelioid cell granulomas in 25 of 29 patients (86%; 95% confidence interval 73–100) with the final diagnosis of sarcoidosis. No complications were observed. Conclusions: Transesophageal bronchoscopic ultrasound-guided fine needle aspiration is feasible, safe and accurate for the diagnosis of stage I/II sarcoidosis.

Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis

“…1). 11,[24][25][26][27][28][29][30][31][32] All studies were observational; 6 were prospective, 24,25,27,29,30,32 and 4 had a retrospective design (Table 1). 11,26,28,31 Five studies were aimed at mediastinal staging of lung cancer, [24][25][26]31,32 using a combination of EBUS-TBNA and EUS-B-FNA (Table 1).…”

“…One study each was performed for the diagnosis of sarcoidosis, diagnosis of mediastinal lesions, molecular diagnosis of lung cancer, restaging of lung cancer after chemotherapy, and diagnosis of suspected malignant mediastinal lesions in those with non-diagnostic conventional techniques. 11,[27][28][29][30] The procedure was performed by pulmonologist(s) in 7 studies, a surgeon in one study, and both pulmonologists and surgeons in 2 studies ( Table 2). The various nodal stations accessed by EBUS-TBNA or EUS-B-FNA are also listed in Table 2.…”

“…The demonstration of malignancy by EBUS-TBNA and/or EUS-B-FNA was taken as true positive in all the studies, whereas surgical confirmation and/or follow-up was used in case of benign pathology (Table 3). A 22 gauge TBNA needle was used in most of the studies, a 21 gauge needle was used in a single study, 29 and one study did not report the needle size. 25 Rapid on-site cytological examination was not performed in any study.…”

“…5) or on statistical tests (Begg-Mazumdar: Kendall's tau ϭ 0.3333, P ϭ .75; Egger: bias ϭ Ϫ0.2799, P ϭ .91). 26 Appropriate pulmonary resection with systemic lymph node dissection of the mediastinal nodes in those with negative results Bugalho 27 Malignancy: positive result by any method established as evidence; benign disease: confirmed by surgical procedures Araya 28 Not available Oki 29 Diagnosis of sarcoidosis: clinicoradiological features compatible with sarcoidosis, pathological findings of noncaseating granulomas, exclusion of other causes of granulomas, clinical follow-up Szlubowski 30 Malignancy: positive cytologic result of malignancy accepted as evidence of cancer; in subjects with negative results of EUS-B-FNA, transcervical extended mediastinal lymphadenectomy was performed Lee 31 Malignancy: defined by pathological confirmation via EBUS-TBNA, EUS-B-FNA, mediastinoscopy, or mediastinal lymph node dissection; benign disease: confirmed by surgery Oki 32 Malignancy: positive findings from the needle aspiration procedure were regarded as true-positive; benign disease: confirmed by lack of lymph node progression on CT over 6 mo EUS-B-FNA ϭ endoscopic ultrasound with bronchoscope-guided fine-needle aspiration EBUS-TBNA ϭ endobronchial ultrasound-guided transbronchial needle aspiration CT ϭ computed tomography …”

“…With most studies in this systematic review aimed at mediastinal staging of cancer, larger randomized trials from different centers, assessing the utility of this technique for other causes of mediastinal lymphadenopathy, are required to confirm the results of this meta-analysis. 11 Inaccessible by EBUS-TBNA, technical difficulty of EBUS-TBNA, intolerance of bronchoscopy due to cough or dyspnea, brain metastasis with mass effect, medical condition precluding bronchoscopy (ischemic heart disease) Hwangbo 24 Inaccessible by EBUS-TBNA, well visualized areas by EUS-B-FNA, technical difficulty of EBUS-TBNA Herth 25 Inaccessible by EBUS-TBNA Szulobowski 26 Inaccessible by EBUS-TBNA, patient comfort Bugalho 27 Inaccessible by EBUS-TBNA Araya 28 Inaccessible by EBUS-TBNA, poor performance status, poor respiratory condition Oki 29 Not reported Szlubowski 30 Not reported Lee 31 Inaccessible by EBUS-TBNA Oki 32 Inaccessible by EBUS-TBNA, technical difficulty of EBUS-TBNA EUS-B-FNA ϭ endoscopic ultrasound with bronchoscope-guided fine-needle aspiration EBUS-TBNA ϭ endobronchial ultrasound-guided transbronchial needle aspiration…”