Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Pulmonary Sarcoidosis Diagnosed by Endobronchial Ultrasound Fine Needle Aspiration

초음파 기관지 내시경 세침흡인을 이용하여 진단한 폐 사르코이드증

  • Kim, Won-Young (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chang, You-Jin (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lyu, Ji-Won (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Young-Soo (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jang, Se-Jin (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Jin-Woo (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Yeon-Mok (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shim, Tae-Sun (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Do (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Woo-Sung (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Dong-Soon (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Chang-Min (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 김원영 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 장유진 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 류지원 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 박영수 (울산대학교 의과대학 서울아산병원 병리학교실) ;
  • 장세진 (울산대학교 의과대학 서울아산병원 병리학교실) ;
  • 송진우 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 최창민 (울산대학교 의과대학 서울아산병원 호흡기내과학교실)
  • Received : 2010.03.21
  • Accepted : 2010.04.20
  • Published : 2010.05.30
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Abstract

Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

Keywords

References

  1. Boeck C. Multiple benign sarkoid of the skin. J Cutan Genitourin Dis 1899;17:543-50.
  2. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007;357:2153-65. https://doi.org/10.1056/NEJMra071714
  3. Lynch JP 3rd, Kazerooni EA, Gay SE. Pulmonary sarcoidosis. Clin Chest Med 1997;18:755-85. https://doi.org/10.1016/S0272-5231(05)70417-2
  4. Trisolini R, Tinelli C, Cancellieri A, Paioli D, Alifano M, Boaron M, et al. Transbronchial needle aspiration in sarcoidosis: yield and predictors of a positive aspirate. J Thorac Cardiovasc Surg 2008;135:837-42. https://doi.org/10.1016/j.jtcvs.2007.11.011
  5. Wang KP, Fuenning C, Johns CJ, Terry PB. Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis. Ann Otol Rhinol Laryngol 1989;98:298-300. https://doi.org/10.1177/000348948909800412
  6. Morales CF, Patefield AJ, Strollo PJ Jr, Schenk DA. Flexible transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest 1994;106:709-11. https://doi.org/10.1378/chest.106.3.709
  7. Leonard C, Tormey VJ, O'Keane C, Burke CM. Bronchoscopic diagnosis of sarcoidosis. Eur Respir J 1997;10: 2722-4. https://doi.org/10.1183/09031936.97.10122722
  8. Bilaceroglu S, Perim K, Gunel O, Cagirici U, Buyuksirin M. Combining transbronchial aspiration with endobronchial and transbronchial biopsy in sarcoidosis. Monaldi Arch Chest Dis 1999;54:217-23.
  9. Trisolini R, Lazzari Agli L, Cancellieri A, Poletti V, Tinelli C, Baruzzi G, et al. The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis. Chest 2003;124:2126-30. https://doi.org/10.1378/chest.124.6.2126
  10. Oki M, Saka H, Kitagawa C, Tanaka S, Shimokata T, Kawata Y, et al. Real-time endobronchial ultrasoundguided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology 2007;12:863-8. https://doi.org/10.1111/j.1440-1843.2007.01145.x
  11. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax 2003; 58:1083-6. https://doi.org/10.1136/thorax.58.12.1083
  12. Garwood S, Judson MA, Silvestri G, Hoda R, Fraig M, Doelken P. Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis. Chest 2007;132:1298-304. https://doi.org/10.1378/chest.07-0998
  13. Joyner LR, Scheinhorn DJ. Transbronchial forceps lung biopsy through the fiberoptic bronchoscope: diagnosis of diffuse pulmonary disease. Chest 1975;67:532-5. https://doi.org/10.1378/chest.67.5.532
  14. Koonitz CH, Joyner LR, Nelson RA. Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis. Ann Intern Med 1976;85:64-6. https://doi.org/10.7326/0003-4819-85-1-64
  15. Tremblay A, Stather DR, Maceachern P, Khalil M, Field SK. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest 2009;136:340-6. https://doi.org/10.1378/chest.08-2768
  16. Gupta D, Mahendran C, Aggarwal AN, Joshi K, Jindal SK. Endobronchial vis a vis transbronchial involvement on fiberoptic bronchoscopy in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2001;18:91-2.
  17. Chapman JT, Mehta AC. Bronchoscopy in sarcoidosis: diagnostic and therapeutic interventions. Curr Opin Pulm Med 2003;9:402-7. https://doi.org/10.1097/00063198-200309000-00011
  18. Reich JM, Brouns MC, O'Connor EA, Edwards MJ. Mediastinoscopy in patients with presumptive stage I sarcoidosis: a risk/benefit, cost/benefit analysis. Chest 1998;113:147-53. https://doi.org/10.1378/chest.113.1.147
  19. Baughman RP, Iannuzzi MC. Diagnosis of sarcoidosis: when is a peek good enough? Chest 2000;117:931-2. https://doi.org/10.1378/chest.117.4.931
  20. Itoh T, Kobayashi D, Shiratuchi N, Rensha K, Minami K. Case of overlapping cancers complicated with sarcoidosis. Nihon Kokyuki Gakkai Zasshi 2009;47: 410-4.

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  2. Teaching Conventional Transbronchial Needle Aspiration. A Continuum vol.10, pp.6, 2010, https://doi.org/10.1513/annalsats.201308-272ed