Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in pulmonary sarcoidosis compared with transbronchial lung biopsy and endobronchial biopsy

Objective To compare the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and traditional diagnostic approaches of transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB) in pulmonary sarcoidosis. Methods Totally 78 patients with clinically and radiographically suspected sarcoidosis in Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University from January 2010 to January 2015 were retrospectively analyzed. Of them, 57 underwent EBUS-TBNA and 21 underwent traditional diagnostic approaches of TBLB or EBB. Presence of non-caseating epithelioid cell was pathologic evidence of sarcoidosis. Results Among 57 patients who underwent TBLB or EBB, 38 patients had positive pathologic results. The sensitivity of TBLB/EBB was 66.6% (38/57). Five patients had pneumothorax after TBLB. At EBUS-TBNA, 42 mediastinal and hilar lymph nodes in 21 patients were aspirated. The average axis diameter was (1.845±0.418) cm. There were 20 patients with positive results. During follow-up, 19 patients had the final diagnosis of sarcoidosis and 1 patient was diagnosed as pulmonary tuberculosis. The sensitivity of EBUS-TBNA was 90.4% (19/21), which was significantly higher than that of traditional diagnostic approaches of TBLB or EBB. No major procedure-related complications were observed, which was no significant difference compared with traditional diagnostic approaches group (Fisher exact probability method, P=0.316). Conclusion EBUS-TBNA was a safe and effective method for diagnosing pulmonary sarcoidosis and should be considered as the first choice for the histopathologic diagnosis of stage Ⅰ and Ⅱ sarcoidosis. Key words: Endobronchial ultrasound; Sarcoidosis; Lymph nodes