PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate and minimally invasive technique used routinely for investigation of mediastinal and hilar lymphadenopathy. However, few studies have addressed its role in comparison to the traditional diagnostic approaches of transbronchial lung biopsy (TBLB), endobronchial biopsy (EBB), and bronchoalveolar lavage (BAL) in the diagnosis of sarcoidosis. We evaluated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis compared to TBLB, EBB, and BAL. MATERIALS AND METHODS: Consecutive patients with suspected sarcoidosis (stage I and II) on chest radiography and chest computed tomography were included. All 33 patients underwent EBUS-TBNA, TBLB, EBB, and BAL during the same session between July 2009 and June 2011. EBUS-TBNA was performed at 71 lymph node stations. RESULTS: Twenty-nine of 33 patients, were diagnosed with histologically proven sarcoidosis; two patients were compatible with a clinical diagnosis of sarcoidosis during follow-up; and two patients were diagnosed with metastatic carcinoma and reactive lymphadenopathy, respectively. Among 29 patients with histologically proven sarcoidosis in combination with EBUS-TBNA, TBLB, and EBB, only EBUS-TBNA and TBLB revealed noncaseating granuloma in 18 patients and one patient, respectively. The overall diagnostic sensitivities of EBUS-TBNA, TBLB, EBB, and BAL (CD4/CD8 > or =3.5) were 90%, 35%, 6%, and 71%, respectively (p<0.001). The combined diagnostic sensitivity of EBUS-TBNA, TBLB, and EBB was 94%. CONCLUSION: EBUS-TBNA was the most sensitive method for diagnosing stage I and II sarcoidosis compared with conventional bronchoscopic procedures. EBUS-TBNA should be considered first for the histopathologic diagnosis of stage I and II sarcoidosis.
Adult ; Aged ; Biopsy, Fine-Needle/*methods ; Bronchoscopy ; Female ; Humans ; Lymph Nodes/pathology ; Male ; Middle Aged ; Sarcoidosis/*diagnosis/*ultrasonography ; Young Adult

BACKGROUNDEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods.

METHODSWe searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 (Nordic Cochrane Center, Copenhagen, Denmark) and Stata 12.0 software (Stata Corporation, College Station, TX, USA). The Mantel-Haenszel method was used to calculate the pooled odds ratio (OR) and 95% confidence intervals (CIs).

RESULTSSixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy (TBLB) for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 (95% CI, 2.20-15.79, P = 0.0004). These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA + TBLB + endobronchial biopsy (EBB) versus TBNA + TBLB + EBB was 1.54 (95% CI, 0.61-3.93, P = 0.36), implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables.

CONCLUSIONSThe results of this meta-analysis suggest that EBUS-TBNA + TBLB + EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA + TBLB + EBB could be used instead.

Biopsy, Fine-Needle ; methods ; Bronchoscopy ; methods ; Endosonography ; methods ; Female ; Humans ; Image-Guided Biopsy ; methods ; Male ; Sarcoidosis, Pulmonary ; diagnosis ; Ultrasonography ; methods

No abstract available.
Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Neck/diagnostic imaging ; Parotid Gland/*pathology ; Parotid Neoplasms/diagnosis/diagnostic imaging/pathology ; Sarcoidosis/*diagnosis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography

Sarcoidosis is a multisystem granulomatous disorder commonly affecting young adults. Diagnosis is confirmed by evidence of non-caseating granuloma in more than one organ. A case is presented where the diagnosis was made on a bone marrow biopsy, the first case in Korea. A 54-year-housewife was admitted because of multiple variable sized, skin papules and macules, who showed pancytopenia and evidence of liver cirrhosis on ultrasound. We performed skin biopsy and bone marrow biopsy, which showed non-caseating granulomas. The chest CT, opthalmologic examination was performed and showed the involvement of sarcoidosis of mediastinal lymph nodes and uvea. Multiple joints of both hands and feet also seemed to be involved in view of simple X-ray. By this case, we emphasize the significance of bone marrow biopsy in the sarcoidosis with pancytopenia.
Biopsy ; Bone Marrow* ; Diagnosis ; Foot ; Granuloma ; Hand ; Humans ; Joints* ; Korea ; Liver Cirrhosis ; Liver* ; Lymph Nodes ; Pancytopenia ; Sarcoidosis* ; Skin* ; Tomography, X-Ray Computed ; Ultrasonography ; Uvea* ; Young Adult

BACKGROUND: Since the introduction of endobronchial ultrasound (EBUS)–guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes, the incidence of histopathologically-confirmed sarcoidosis has increased. METHODS: The electronic medical records of Chonnam National University (CNU) Hospital and CNU Hwasun Hospital (CNUHH) were searched for confirmed cases of sarcoidosis diagnosed between 1996 and 2014. Cases were selected using a combination of clinical, radiological, and pathological evidence. Of 115 cases with the relevant disease codes, 16 cases were excluded, as they had not been confirmed pathologically or had no definitive clinical features of sarcoidosis. RESULTS: Among 99 cases of confirmed sarcoidosis, only nine patients were diagnosed with sarcoidosis before 2008; the rest were diagnosed from 2008 onward, after the introduction of EBUS-TBNA. EBUS-TBNA was used in 75.8% of patients, open surgical biopsy in 13.2%, and mediastinoscopic biopsy in 5.1%. At the time of diagnosis, 42.4% of sarcoidosis cases were at stage I, 55.6% at stage II, and 2% at stage III. Spontaneous remission of sarcoidosis was observed in 33.3% of cases, and stable disease in 37.4%; systemic steroid treatment was initiated in 23.2% of cases. Of the patients treated with systemic steroids, 69.6% showed improvement. The median duration of steroid treatment was 5 months. CONCLUSION: Following the introduction of EBUS-TBNA, the number of newly diagnosed sarcoidosis patients has increased. Clinical features of sarcoidosis were similar to those previously reported. Spontaneous remission occurred in about one-third of patients, while one-fourth of patients required systemic steroid treatment.
Biopsy ; Bronchoscopy ; Diagnosis ; Electronic Health Records ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Incidence ; Jeollanam-do ; Korea* ; Lymph Nodes ; Needles ; Remission, Spontaneous ; Sarcoidosis* ; Steroids ; Ultrasonography