Conventional Transbronchial Needle Aspiration Research Articles

The Impact of EBUS vs Conventional TBNA on Adequacy, Diagnostic Yield, and Fellows Training at a Major Academic Center

The Impact of EBUS vs Conventional TBNA on Adequacy, Diagnostic Yield, and Fellows Training at a Major Academic Center

Endobronchial ultrasound: what is it and when should it be used?

Endobronchial ultrasound has become increasingly used in the UK as a lung cancer staging and diagnostic tool. It has many applications especially in the mediastinal lymph nodes but also the vascular structures as well as the airway wall itself. It is superior to conventional transbronchial needle aspiration in lung cancer staging and diagnosis of mediastinal lymphadenopathy. With time it may well replace mediastinoscopy completely for staging lung cancer. There are, however, training issues and revenue-based tariff systems have been slow to reflect this innovation. Future developments may include routine use in the assessment of central pulmonary vasculature and assessment of airway wall remodelling.

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration versus conventional transbronchial needle aspiration

Conventional endoscopic transbronchial needle aspiration (TBNA) is a common procedure used to obtain samples for diagnosing and staging lung lesions. Recently, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been developed and increasingly used by clinicians. Clinical data suggest that EBUS-TBNA has higher sensitivity and specificity than conventional TBNA in staging lung cancers. In this study, the authors have investigated the cytological features and compared the diagnostic yield of these procedures in lung cancer patients. A computer search of the cytopathology archives at The Johns Hopkins Hospital revealed 188 EBUS-TBNA cases (308 lymph nodes; 47 lung lesions) and 74 TBNA cases (106 lymph nodes; 44 lung lesions) over a 28-month period. All cytological material was correlated with available corresponding surgical material. The most frequently sampled lymph nodes were stations 4R and 7 in both TBNA and EBUS-TBNA; in addition, the EBUS-TBNA showed a wide range of lymph node sampling. EBUS-TBNA had a significantly lower nondiagnostic rate (8.7%) compared with TBNA (28.3%, P < .05) in staging lung cancers. In lymph node sampling, the sensitivity and specificity were 54.5% and 100% in the TBNA group and 85.2% and 100% in the EBUS-TBNA group. In lung specimens, the nondiagnostic rates of TBNA and EBUS-TBNA were 6.8% and 4.3%, respectively (P > .05), and the sensitivity and specificity were 78.9% and 100% in the TBNA group; and 89.5% and 100% in the EBUS-TBNA group. Findings indicated that EBUS-FNA cytology is an optimal modality for diagnosing and staging in lung cancer patients, in comparison to conventional TBNA.

Mediastinal cryptococcosis masquerading as therapy-refractory lymphoma

Dear Editor, A 58-year-old woman presented with a 1-month history of abdominal pain and weight loss. Positron emission tomography computerized tomography (PET-CT) showed markedly thickened and hypermetabolic small bowel (standardized uptake value maximum, SUVmax: 8.7) associated with multiple abdominal and pelvic lymphadenopathy (Fig. 1a). Intestinal obstruction soon developed, necessitating small bowel resection. Histologic examination showed enteropathy-associated T-cell lymphoma. She was treated with three cycles of chemotherapy comprising steroid, methotrexate, ifosphamide, l-asparaginase, and etoposide [1]. Interim reassessment PET-CT showed complete resolution of the abdominal and pelvic lesions (Fig. 1b). However, new pretracheal, precarinal, subcarinal, and left hilar lymphadenopathy (SUVmax, 7.4; Fig. 1b, arrows) developed. The patient was afebrile with no respiratory symptoms. Owing to discrepant responses of lymphadenopathy to chemotherapy, further diagnostic evaluation was pursued. To avoid general anesthesia necessary for mediastinoscopy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) was performed under local anesthesia with conscious sedation. Multiple mediastinal lymph nodes located in the upper, lower paratracheal, and subcarinal area were aspirated. Conventional fiberoptic bronchoscopy was also performed with no endobronchial abnormality detected. Both cytologic and histologic specimens obtained from all sampled lymph nodes demonstrated epithelioid-like cells and multinucleated giant cells, with no atypical lymphoid cells found. Roundish spore-like organisms were indentified (Fig. 2a, arrows). These organisms were positive for the fungal mucicarmine (Fig. 2b, arrows) and Grocott stains. The histopathologic features were consistent with cryptococcal lymphadenitis. Serum cryptococcal antigen was also positive at 1:16. The cerebrospinal fluid was normal. She was treated with oral fluconazole (400 mg daily). A PET-CT scan after 6 weeks of fluconazole showed that the mediastinal lymphadenopathy had largely resolved. Fig. 1 Positron emission tomography. a Before treatment, showing massive bowel and pelvic involvement (arrows). b After chemotherapy, showing resolution of all previous lesions, but matted mediastinal lymphadenopathy of similar metabolic activity as the original ... Fig. 2 Lymph node findings. a Histologic examination showed numerous spore-like organisms (arrows). b The organisms were positive for the fungal stain mucicarmine (arrows) Cryptococcal infection usually results from inhalation of fungal spores, and may be confined to the lungs or disseminate systemically. Radiologically, pulmonary cryptococcosis may present as a single well-defined consolidation or mass, diffusely scattered nodules or reticulonodules [2]. Cryptococcal lymphadenopathy, especially affecting the mediastinum, is infrequent and mainly reported in patients infected with the human immunodeficiency virus (HIV) [3, 4]. Radiologically, in HIV-negative patients, pulmonary cryptococcal infection usually presents as large nodular lesions or alveolar infiltrates. In HIV-infected patients, lymphadenopathy and interstitial infiltrates are instead the common findings [5]. In cryptococcal lymphadenitis, lymph nodes are generally <1.5 cm and accompanied by pulmonary parenchymal changes [6]. Hence, the extensive multifocal mediastinal lymphadenopathy without parenchymal lesions in our patient was more consistent radiologically with lymphoma progression. However, suitable investigations finally revealed the correct diagnosis. Conventional transbronchial needle aspiration with a histology needle in immunocompromised patients with intrathoracic lymphadenopathy has a poor diagnostic yield [7]. EBUS-TBNA with a designated 22-gauge needle has significant advantages. In addition to a high diagnostic yield for mediastinal lymphadenopathy, both histologic and cytologic specimens can be obtained. A histological specimen aids in the diagnosis of non-malignant mediastinal lymphadenopathy such as sarcoidosis, as well as eliminates the possibility of false-positive microbiologic results from contamination by airway colonization. Our case illustrated well the utility of EBUS-TBNA as a minimally invasive technique in clinching the diagnosis.

Comparative Effectiveness of Low- and High-Fidelity Bronchoscopy Simulation for Training in Conventional Transbronchial Needle Aspiration and User Preferences

Background: Conventional transbronchial needle aspiration (TBNA) can be learned using high-fidelity virtual-reality platforms and low-fidelity models comprised of molded silicone or excised animal airways. Objectives: The purpose of this study was to determine perceptions and preferences of learners and instructors regarding the comparative effectiveness of low-fidelity and high-fidelity bronchoscopy simulation for training in TBNA. Methods: During the 2008 annual CHEST conference, a prospective randomized crossover design was used to train study participants in three methods of conventional TBNA using low- and high-fidelity models. Likert style questions were administered to learners and instructors in order to elicit preferences and opinions regarding educational effectiveness of the models. Results were tabulated and depicted in graphic format, with medians calculated. Results: Learners felt that the models were equally enjoyable (13–13) and enthusiasm generating (low 17-high 15). There was preference for low-fidelity in terms of realism (23–17), ease of learning (20–6), and learning all three TBNA methods (31–7 for hub-against-wall, 31–6 for jabbing, 29–6 for piggyback). Low-fidelity was preferred as an ideal model overall (19–11). Instructors thought that low-fidelity was more useful in teaching TBNA (9–0 for all three methods). Instructors perceived the low-fidelity model overall as an ideal tool for learning TBNA (8–0) and a more effective teaching instrument (8–0). Conclusion: Based on learner and instructor perceptions, a low-fidelity model is superior to a high-fidelity platform for training in three methods of conventional TBNA.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of lung cancer

The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) bronchoscope has a built-in miniaturized ultrasound probe that facilitates real-time TBNA biopsies. The sensitivity of EBUS-TBNA in lung cancer is 88% to 90% and specificity is 100%. The test performance is excellent with an area under the summary receiver operating characteristics curve of 0.99. This diagnostic yield clearly exceeds that of conventional blind TBNA. However, the false negative rate remains high, about 20%. Therefore, negative aspirates need to be confirmed with mediastinoscopy, surgical sampling or clinical follow up. Restaging the mediastinum after neoadjuvant chemotherapy has had less success with a reported EBUS-TBNA sensitivity of only 76% and a negative predictive value of 20%. The procedure has also been used to successfully obtain biopsy specimens in primary tumors located in the paratracheal and peribronchial region with a sensitivity of 82 to 94%. The benefit of EBUS-TBNA is that it can be performed under moderate sedation in an outpatient setting without ionizing radiation. Although the current practice in most institutions remains targeted sampling of enlarged lymph nodes, complete staging of a radiologically normal mediastinum is also possible. Therefore, EBUS-TBNA can be considered one of the first-line modalities for the diagnosis and invasive staging of lung cancer if the equipment and expertise are available.

A strategy to improve the yield of transbronchial needle aspiration

Transbronchial needle aspiration (TBNA) is a bronchoscopic technique that provides access to masses within the mediastinum. It is operator dependent, and factors such as needle type, lymph node site, and endobronchial ultrasosonography (EBUS) have been implicated as having an impact on its accuracy. This study aimed to develop a strategy for TBNA and specimen preparation techniques as the first step toward improving TBNA yield, and to determine whether EBUS can augment its application. Intervention included standardizing the use of the histology needle and the direct smear method. As competency improved, radial probe (RP) and linear EBUS were incorporated into TBNA. The study assessed 35 conventional TBNA procedures before and 45 of these procedures after intervention as well as 45 RP-EBUS and 50 linear EBUS-guided TBNA procedures. Frequently sampled lymph node stations were 7, 4R, and 4L in the American Thoracic Society classification. The preintervention conventional TBNA yield was 43%, which improved to 82% after intervention. Although EBUS did not have an impact on TBNA yield (p = 0.44) compared with the intervention (p = 0.001), EBUS was useful for lymph nodes smaller than 2 cm (p < 0.0001). Linear EBUS did not confer higher diagnostic accuracy than RP-EBUS (p = 0.47). Proper TBNA and specimen preparation techniques are the first steps toward improving TBNA yield, and EBUS can be used to guide TBNA of small lymph nodes.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) as a Diagnostic Tool for the Evaluation of Mediastinal Pathology: The Leicester Experience

Endobronchial ultrasound (EBUS) is a recently developed and evolving tool that enables sampling of mediastinal lymph nodes and other peribronchial tissues using real-time ultrasonic image guidance. Studies to date report superior diagnostic specificity and sensitivity with EBUS, compared with conventional transbronchial needle aspiration performed without image guidance. Furthermore, the specificity of EBUS for malignant mediastinal lymph node disease is comparable to the gold standard of surgical mediastinoscopy. As a clinical tool, EBUS is a minimally invasive, out-patient procedure that is fast transforming diagnostic pathways for mediastinal pathology. In this article, we summarise the technical aspects of EBUS and present our local clinical experience of 18 months.

COMPARISON OF CONVENTIONAL TRANSBRONCHIAL NEEDLE ASPIRATION (TBNA) VS ENDOBRONCHIAL ULTRASOUND-GUIDED (EBUS) TRANSBRONCHIAL NEEDLE ASPIRATION WITH AND WITHOUT RAPID ONSITE EVALUATION (ROSE) IN A SINGLE CENTER

PURPOSE: Conventional transbronchial needle aspiration (TBNA) has a number of limitations. Endobronchial ultrasound (EBUS TBNA) has significantly improved the diagnostic capability of mediastinal lymph node sampling. We present our experience with conventional TBNA with and without rapid onsite evaluation (ROSE) compared with EBUS TBNA with and without ROSE.

Endobronchial Ultrasound in Lung Cancer Staging

In Brief Endobronchial ultrasound (EBUS) is a minimally invasive staging method that has emerged as a potential alternative to mediastinoscopy in lung cancer staging. The radial probe EBUS was initially developed in the 1990s and demonstrated to be a technique with a higher diagnostic yield than conventional blind transbronchial needle aspiration, with a pooled sensitivity of 78%. The new EBUS-guided fine needle aspiration (EBUS-FNA) is a real-time ultrasonographically visualized puncture that achieves a sensitivity of 92.5%, a negative predictive value of 91% and a diagnostic accuracy of 95% on average. Lymph nodes down to 5 mm can be successfully sampled and there are no reports of major complications. The combination of EBUS-FNA and transesophageal ultrasound FNA (EUS-FNA) provides complementary and near global staging of the mediastinum, covering more lymph node stations than mediastinoscopy alone. A potential lung cancer algorithm of the future would use endoscopic minimally invasive approaches and restrict diagnostic surgical procedures to negative needle cytology results. Endobronchial ultrasound with fine-needle aspiration is a real time biopsy technique that enables minimally invasive staging of lung cancer. This article describes the basic technical information, the indications, and the outcomes, and proposes a staging algorithm of the future.

Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy

There is increasing awareness of minimally invasive endoscopic techniques for mediastinal staging in lung cancer. Traditionally, cervical mediastinoscopy has been utilized. Endobronchial ultrasound-guided fine needle aspiration (EBUS) has recently emerged as a potential alternative. EBUS has sensitivity for lung cancer which is at least equivalent (if not superior) to cervical mediastinoscopy. However, cervical mediastinoscopy remains superior to EBUS and other techniques in its high negative predictive value. More recent data suggest EBUS may have a role in presurgical staging of radiologically normal subcentimetre nodes and its negative predictive value may be equivalent to surgical staging. Ongoing comparative studies between EBUS and cervical mediastinoscopy may well clarify relative performance and cost analyses. Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.

Real-time endobronchial ultrasound-guided transbronchial needle aspiration: preliminary study on mediastinal and hilar lymph nodes of lung cancer

To observe the value and safety of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) on mediastinal and hilar lymph nodes of lung cancer. During July 2008 to December 2008, 25 patients (18 males, 7 females), (68 +/- 9) years old, with proven or radiologically suspected lung cancer were enrolled. EBUS-TBNA was performed to obtain samples from 28 lymph nodes of these patients. And 28 lymph nodes of 26 same eligible patients [(18 males, 8 females, (66 +/- 8) years old] were sampled with conventional TBNA by the same operator during January 2008 to June 2008. A positive result was either a specific diagnosis (eg, malignant cells) or a lymphocyte-positive specimen. The results and complications of EBUS-TBNA versus conventional TBNA were compared. The yield of EBUS-TBNA, 92.9%, was significantly higher than 60.7% (17/28 nodes) of conventional TBNA (chi2 = 8.114, P = 0.004). No pneumothorax, airway rupture, hemorrhage (> 5 ml) and other complications were observed for the patients operated with EBUS-TBNA and conventional TBNA. Real-time EBUS guidance significantly increases the yield of TBNA on mediastinal and hilar lymph nodes of lung cancer, and EBUS-TBNA is safe. Further application studies are needed.

Usefulness of Radial Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Mediastinal Lymph Nodes

Introduction Transbronchial needle aspiration (TBNA) is a bronchoscopic technique that has been shown to be useful for sampling mediastinal lymph nodes. The yield of this technique can be increased by using endobronchial ultrasound (EBUS) to guide needle placement. The aim of the present study was to compare the yield of EBUS-guided TBNA to that of conventional TBNA in the analysis of mediastinal lymph nodes. Patients and Methods All patients undergoing either EBUS-guided or conventional TBNA for the diagnosis of mediastinal lymph nodes between January 2006 and May 2007 were studied consecutively. Histology results were used as a reference standard in patients treated surgically. In cases in which surgery was not indicated, the results of cytology or of clinical follow-up of at least 6 months duration were used. Results TBNA was performed in 117 patients and a total of 143 lymph nodes were punctured (mean shortest [SD] diameter, 17.9 [8] mm). The samples obtained were diagnostic in 58 patients (49.6%) and in 70 lymph nodes (49.0%). For paratracheal and hilar stations, the yield of EBUS-guided TBNA was superior to that of conventional TBNA (59.2% compared to 34.1%, P=.02). Conclusions Radial EBUS guidance increases the diagnostic yield of TBNA in paratracheal and hilar lymph node stations.

Utilidad de la punción aspirativa transbronquial guiada con ultrasonografía endobronquial (USEB) radial para el diagnóstico de adenopatías mediastínicas

Introduction Transbronchial needle aspiration (TBNA) is a bronchoscopic technique that has been shown to be useful for sampling enlarged mediastinal lymph nodes. The yield of this technique can be increased by using endobronchial ultrasound (EBUS) to guide needle placement. The aim of the present study was to compare the yield of radial EBUS-guided TBNA to that of conventional TBNA in the analysis of mediastinal lymph nodes. Patients and Methods All patients undergoing either EBUS-guided or conventional TBNA for the diagnosis of mediastinal lymph nodes between January 2006 and May 2007 were studied consecutively. Histology results were used as a reference standard in the patients treated surgically. In cases in which surgery was not indicated, the results of cytology or of clinical follow-up of at least 6 months duration were used. Results TBNA was performed in 117 patients, and a total of 143 lymph nodes were punctured (mean shortest [SD] diameter, 17.9 [8] mm). The samples obtained were diagnostic in 58 patients (49.6%) and in 70 lymph nodes (49.0%). For paratracheal and hilar stations, the yield of radial EBUS-guided TBNA was superior to that of conventional TBNA (59.2% compared to 34.1%, P=.02). Conclusions Radial EBUS guidance increases the diagnostic yield of TBNA in paratracheal and hilar lymph node stations.

Cytological assessment of conventional transbronchial fine needle aspiration of lymph nodes

Transbronchial fine needle aspiration (TBNA) is a minimally invasive bronchoscopic technique that allows pathological examination of mediastinal and hilar lymph nodes. The aim of this study was to assess the cytopathological outcome of TBNA. One hundred and eighty-seven patients who underwent TBNA of mediastinal and hilar lesions from May 2000 to June 2007 were reviewed. TBNA results were considered to be adequate if the cytological material revealed a malignant lesion or sufficient number of benign lymphoid cells. In the current study, 40 cases (21.9%) were reported as inadequate. When inadequate tests were excluded, the overall sensitivity and accuracy of TBNA in the diagnosis of malignant lesions were 83.5% and 88.0% respectively. The lowest sensitivity was noted in lymph node involvement by lymphoma. Regarding the workload associated with TBNA cytology, we found that the average number of conventionally prepared cytological slides per case was high (17 slides per case). Our results confirm that conventional TBNA is a sensitive and useful technique but it is relatively expensive and the protocols should be adapted to allow appropriate material to be collected for ancillary diagnostic tests.

Diagnosis of Mediastinal Adenopathy—Real-Time Endobronchial Ultrasound Guided Needle Aspiration versus Mediastinoscopy

Real-time endobronchial ultrasound has increased the accuracy of conventional transbronchial needle aspiration biopsy in sampling mediastinal lymph nodes. Nevertheless, direct comparisons with mediastinoscopy are not available to determine the role of endobronchial ultrasound in pathologic staging. To compare the diagnostic yield of endobronchial ultrasound against cervical mediastinoscopy in the diagnosis and staging of radiologically enlarged mediastinal lymph nodes stations accessible by both modalities in patients with suspected nonsmall cell lung cancer. Prospective, crossover trial with surgical lymph node dissection used as the accepted standard. Biopsy results of paratracheal and subcarinal lymph nodes were compared. Sixty-six patients with a mean age 60 +/- 10 years were studied. The prevalence of malignancy was 89% (59/66 cases). Endobronchial ultrasound had a higher overall diagnostic yield (91%) compared with mediastinoscopy (78%; p = 0.007) in the per lymph node analysis. There was disagreement in the yield between the two procedures in the subcarinal lymph nodes (24%; p = 0.011). There were no significant differences in the yield at other lymph node stations. The sensitivity, specificity, and negative predictive value of endobronchial ultrasound were 87, 100, and 78%, respectively. The sensitivity, specificity, and negative predictive value of mediastinoscopy were 68, 100, and 59%, respectively. No significant differences were found between endobronchial ultrasound (93%) and mediastinoscopy (82%; p = 0.083) in determining true pathologic N stage (per patient analysis). In suspected nonsmall cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy.

Endobronchial ultrasound guided transbronchial needle aspiration of mediastinal lymph nodes for lung cancer staging: a projected cost analysis

Endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes provides a safe alternative to mediastinoscopy for staging patients with lung cancer.1–5 Performing TBNA under real time ultrasound visualisation has...

Combined EBUS Real Time TBNA and Conventional TBNA are the Most Cost-effective Means of Lymph Node Staging

Lymph node staging is extremely important for the therapeutic decision in patients suffering from lung cancer. For mediastinal staging in nonsmall cell lung cancer different techniques are available. Most frequently, mediastinoscopy or transbronchial needle aspiration (TBNA) are performed for diagnosis and staging. Endobronchial ultrasound (EBUS) was also introduced for this purpose. In this study, the cost effectiveness of EBUS-guided TBNA and EBUS real time TBNA was compared with standard TBNA and mediastinoscopy. For the 5 different strategies, the actual costs for the procedures of 100 patients were calculated. In the costs analysis, equipment, write-off, personnel, disposable, and costs for histologic and cytologic examination were calculated. The average diagnostic yield for standard TBNA was presumed to be 78%, for EBUS-guided TBNA 85%, and for EBUS real time TBNA 95%. Total costs for standard lymph node staging was 653 EUR/patient, for EBUS staging 720 EUR/patient, for EBUS real time staging 701 EUR/patient, and for mediastinoscopy 1620 EUR/patient. For the combined approach of standard TBNA and EBUS real time TBNA, the total costs were 450 EUR/patient. Standard TBNA combined with EBUS real time TBNA reduces the costs significantly for staging of the mediastinum.

Learning Curve of Conventional Transbronchial Needle Aspiration in Pulmonologists Experienced in Bronchoscopy

Background: Despite its proven efficacy, transbronchial needle aspiration (TBNA) remains an underutilized technique for sampling enlarged mediastinal lymph nodes in the staging of lung cancer. Previous investigators have reported on TBNA experience, but without mentioning individual learning curves related to lymph node size in pulmonologists experienced in bronchoscopy. Objectives: The aim of this study was to evaluate the TBNA learning curve in a group of pulmonologists already experienced in bronchoscopy, and to relate their yields to lymph node size and location. Methods: Data on TBNA yield and related lymph node size were collected retrospectively for five individual pulmonologists. Results: The diagnostic yield of five pulmonologists who started to perform TBNA was evaluated over the first 32 months. TBNA was performed on 138 lymph nodes in 119 patients. The overall diagnostic yield was 77% (range 67–91%). The average diagnostic yield increased from 77% at the start of the learning curve to 82% after 32 months of experience. It was related to lymph node size, but not to lymph node location. The average lymph node size was 22 mm. Conclusions: Satisfactory results were obtained immediately after introduction of TBNA in the bronchoscopy workup. There is no significant TBNA learning curve. The diagnostic yield was related to lymph node size but not to lymph node location.

Real‐time endobronchial ultrasound‐guided transbronchial needle aspiration is useful for diagnosing sarcoidosis

Several studies of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) have reported a sensitivity of approximately 90% in the diagnosis of mediastinal and hilar malignancies. However, few studies have addressed its role in the diagnosis of sarcoidosis. The aim of the present study was to assess the utility of EBUS-TBNA in confirming a pathological diagnosis of sarcoidosis. Fifteen consecutive patients with suspected sarcoidosis and mediastinal and/or hilar lymphadenopathy were investigated prospectively. EBUS-TBNA with an echo-bronchoscope and a dedicated echogenic 22-gauge needle was carried out in patients under conscious sedation, followed by conventional TBNA of the same lesion using a 19-gauge needle. EBUS-TBNA and/or TBNA demonstrated non-caseating epithelioid cell granulomas in 14 of 15 patients (93%). All 14 patients with a pathological diagnosis of sarcoidosis were considered to have sarcoidosis based on subsequent clinical assessments. The single patient with a negative EBUS-TBNA and TBNA had a malignant melanoma diagnosed following surgical biopsy. EBUS-TBNA confirmed a diagnosis of sarcoidosis in 13 of the 14 patients (93%) by identifying non-caseating epithelioid cell granulomas in 18 of 23 lymph nodes (78%) sampled. When two needle aspirates of one or two lymph nodes were carried out, the percentage positive pathological diagnosis for sarcoidosis for (i) EBUS-TBNA; (ii) TBNA; and (iii) the combination of EBUS-TBNA and TBNA were 93% (13 of 14 patients), 93% (13 of 14 patients) and 100% (14 of 14 patients), respectively. There were no complications associated with the procedures. EBUS-TBNA is less invasive and acceptably sensitive as a method for obtaining pathological confirmation of sarcoidosis.