Addition of EBUS-TBNA to bronchoscopic biopsies in the diagnosis of sarcoidosis

Introduction: While the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported in providing sarcoidosis diagnosis, its performance in conjunction with other bronchoscopic sampling methods remains to be clarified. Aims: To evaluate the sensitivity of different diagnostic modalities [EBUS-TBNA, transbronchial biopsy (TBB), endobronchial biopsy (EBB)] performed during the same endoscopic procedure. Methods: We retrospectively reviewed the data of 27 cases of confirmed sarcoidosis that underwent an EBUS procedure between January 2013 and December 2014 in our center. Sensitivity of EBUS-TBNA, TBB and EBB was evaluated in terms of yielding non-caseating granulomas. Results: Mean age of patients was 47 years old (range 30-71), with 16(59.3%) males. According to radiologic features, there were 14(51.9%) stage I and 13(48.1%) stage II. In 13(48.1%) cases, a non diagnostic bronchoscopy had been done before the EBUS. Pathological confirmation of sarcoidosis was established with EBUS procedure in 25(92.6%) cases. TBNA yielded granulomas in 20(74.1%), while EBB and TBB provided diagnosis in 2(7.4%) and 14(51.9%) respectively. TBNA combined with TBB had a diagnostic yield of 92.6%. EBUS-TBNA was performed on a total of 77 lymph node stations (25 hilar and 52 mediastinal). Granulomas were found in 37(48.1%). Core biopsy material with EBUS-TBNA was obtained in 16/77(20.8%), and 12/16(75%) provided diagnosis. Yield of granulomas was greater with lymph node ≥10mm (52.5% vs 11.1%, p=0.02). Conclusion: EBUS with combined samplings should be considered as a first diagnostic procedure in sarcoidosis. Core biopsy material should be obtained from mediastino-hilar lymph nodes.