Suspected Sarcoidosis Research Articles

Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound-Guided Transbronchial Needle Aspirate of the Mediastinal and Hilar Lymph Nodes in Patients with Suspected Sarcoidosis

Background Rapid on-site evaluation (ROSE) is a technique where transbronchial needle aspiration (TBNA) cytology samples are rapidly stained and screened for diagnostic material in the procedure room, during the procedure. We hypothesized the sensitivity of ROSE in patients with sarcoidosis is very low, leading to unjustified use of an expensive technique.Data and Methods This was a retrospective study at an inner-city hospital. Medical records of all patients who underwent EBUS-TBNA of mediastinal and hilar lymph nodes with ROSE over a 3-year period were evaluated. The sensitivity, specificity, and positive and negative predictive values of ROSE in patients with sarcoidosis were calculated, with pathologic diagnosis by cell block as the “gold standard.” Patients with malignancy were used as a comparison. Results One hundred eighty-four patients who had ROSE on EBUS-TBNA of mediastinal and hilar lymph nodes were included. Thirty were diagnosed with sarcoidosis, 95 with malignancy, and 59 with benign lymph nodes. The sensitivity of ROSE in patients with sarcoidosis was 44%, specificity and positive predictive value were 100%, and negative predictive value was only 17%. Conclusion Given low sensitivity and negative predictive value, ROSE may not be as useful in diagnosing sarcoidosis as it is in diagnosing malignancy.

"Can't Intubate Can't Oxygenate" Situation in an Elective Patient in Suspected Sarcoidosis: A Case Report.

The CICO protocol was effective to manage an unanticipated difficult airway. The patient was resuscitated with the use of a microlaryngeal endotracheal tube of the 3rd generation laryngeal mask, placed on the fibrescope.The patient's previous and current medical condition is of vital importance for the pre-operative anaesthetic assessment.Specific questioning during the pre-operative anaesthetic interview could detect events that seem to be insignificant to the patient but are significant for a diagnostic intervention in a new situation.

Incidence and changing patterns of uveitis in Central Tokyo.

The patterns of uveitis in Tokyo have recently changed due to advances in examination tools. We aimed to investigate the changes in the patterns of uveitis between 2004-2015 and 2016-2018. We retrospectively reviewed the data of 732 patients who visited the Uveitis Clinic at the University of Tokyo Hospital between January 2016 and December 2018. Background characteristics, laboratory results, and imaging findings were analysed. We compared the incidences of uveitis in 2016-2018 and 2004-2015 to identify changes in the patterns. The most frequent diagnoses were sarcoidosis (8.9%), herpetic iridocyclitis (6.7%), intraocular lymphoma (5.5%), Vogt-Koyanagi-Harada disease (4.8%), unclassified acute anterior uveitis (4.6%), Behçet's disease (4.5%), bacterial endophthalmitis (2.9%), and Posner-Schlossman syndrome (2.6%). Suspected sarcoidosis (20.9%) was the most common cause of unclassified uveitis. The incidence of intraocular lymphoma was significantly higher in 2016-2018 than in 2004-2015. Between 2004 and 2018, herpetic iridocyclitis, bacterial endophthalmitis, and juvenile chronic iridocyclitis exhibited an increasing trend, and the incidences of Posner-Schlossman syndrome, unclassified acute anterior uveitis, Behçet's disease, and Vogt-Koyanagi-Harada disease exhibited a decreasing trend. The changing patterns of uveitis were characterised by increases in the incidence of intraocular lymphoma. This may be attributed to recent advances in examination tools, the changes in the referred patient population, and the aging Japanese population.

Tissue Sampling in Suspected Sarcoidosis: Can We Avoid Mediastinal Procedures?

Tissue Sampling in Suspected Sarcoidosis: Can We Avoid Mediastinal Procedures?

サルコイドーシスの組織診断を目的とした縦隔リンパ節生検法 : 当院におけるEBUS-TBNAと縦隔鏡検査件数の変遷

サルコイドーシスの組織診断を目的とした縦隔リンパ節生検法 : 当院におけるEBUS-TBNAと縦隔鏡検査件数の変遷

The CD4/CD8 ratio in vitreous fluids is of high diagnostic value in sarcoisosis

SummarySarcoidosis is an idiopathic inflammatory disorder involving multiple organs, and ocular manifestation is one of the common features. A well‐known immunological feature in sarcoidosis is an increased CD4+ helper T cell type 1 lymphocyte subset in BALF. In this study, we investigated the vitreous lymphocyte subsets of sarcoidosis to elucidate the immunological features of this disorder in the eye. Our study enrolled 86 sarcoidosis patients. Diagnoses included 53 eyes with definitive sarcoidosis (D‐S) of 41 patients, 60 eyes with suspected sarcoidosis (S‐S) of 45 patients. Vitreous samples from the uveitis patients were analyzed with flow cytometry. Our result presented that the CD4/CD8 ratio was high in the D‐S/S‐S in the vitreous samples. Moreover, a high CD4+ population indicated sarcoidosis uveitis. Therefore, diagnostic vitrectomy using flow cytometric analysis may be a useful adjunct for the diagnosis of sarcoidosis, particularly in complex cases.

Should Endobronchial Ultrasound be Performed in All Patients with Suspected Sarcoidosis?

techniques (53%). However, diagnostic yield was significantly higher for stage I sarcoidosis (84% vs. 38%, P < 0.001) as compared to stage II sarcoidosis (66% vs. 77%, P = 0.18). Another randomized trial showed that EBUS-TBNA had higher yield (74.5%) compared to conventional TBNA (48.4%), p = 0.004 [4]. Moreover, Tremblay et al [5] showed a significant diagnostic yield of 83.3% in patients who underwent EBUS-TBNA as compared to blind TBNA group 53.8%. Sensitivity and specificity were 60.9% and 100%, in the standard TBNA group vs. 83.3% and 100%, in the EBUS- TBNA group.

Direct Comparison of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and Cervical Mediastinoscopy for the Diagnosis of Suspected Sarcoidosis

Direct Comparison of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and Cervical Mediastinoscopy for the Diagnosis of Suspected Sarcoidosis

Lacrimal Gland Uptake of 67Ga-gallium Citrate Correlates with Biopsy Results in Patients with Suspected Sarcoidosis

Purpose: To investigate whether lacrimal gland uptake on 67Ga-gallium citrate scintigraphy correlates with histopathologic evidence of sarcoidosis.Methods: A retrospective, pilot study of 31 patients with suspected sarcoidosis who underwent gallium scintigraphy and lacrimal gland biopsy. Lacrimal gland gallium uptake was assessed by subjective visual scoring (SVS) and lacrimal uptake ratio (LUR).Results: Eleven (36%) patients had lacrimal gland biopsies containing noncaseating granulomas. A statistically significant correlation was found between lacrimal gland gallium uptake and biopsy positivity using SVS (p = 0.03) or LUR (p = 0.01). Using SVS, biopsy positivity rate increased from 0 to 50% in patients with mild to intense uptake. Using LUR, biopsy positivity rate increased linearly as the ratio increased from 13% (LUR < 4) to 100% (LUR > 8).Conclusions: Lacrimal biopsy positivity rate significantly correlated with gallium uptake on scintigraphy. Both SVS and LUR methods appear to correlate with histologic results and may potentially aid in patient selection for biopsy.

The Role of On-site Cytological Evaluation for Suspected Sarcoidosis

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is emerging as an accurate and safe technique for the evaluation of suspected sarcoidosis. The role of on-site cytological evaluation of TBNA specimens for sarcoidosis remains poorly defined. We sought to evaluate the utility of EBUS-TBNA and specifically the role of on-site cytological evaluation in patients with suspected sarcoidosis.