2017 Volume 39 Issue 1 Pages 7-11
Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for either mediastinal or hilar lymph nodes and transbronchial lung biopsy (TBLB) are useful and highly diagnostic modalities in patients suspected of having sarcoidosis. Objective. The aim of the present study was to retrospectively assess any differences in the medical history and clinical characteristics between patients presenting with sarcoidosis who could not be successfully diagnosed with EBUS-TBNA and those who were successfully diagnosed with EBUS-TBNA. Methods. We analyzed patients suspected of having sarcoidosis who underwent EBUS-TBNA between November 2010 and December 2014 at the Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan. Results. Of the 56 patients examined, EBUS-TBNA pathologically diagnosed sarcoidosis in 51 (91.1%). However, EBUS-TBNA did not result in a diagnosis in the remaining 5 patients (8.9%). These 5 undiagnosed patients showed no marked differences from the other 51 patients with respect to the location of the punctured lymph node, the number of punctures, the average size of the longest lymph node, or the staging based on chest radiography. Three of the 5 patients had insufficient sample volumes to make a diagnosis, while the remaining two showed non-specific pathological changes. Of these 5 patients, Cases 1 and 2 demonstrated non-caseating granulomas by TBLB following EBUS-TBNA, and a second EBUS-TBNA was diagnostic for Case 3. In Case 4, despite undergoing EBUS-TBNA twice, biopsies of both the mediastinal lymph nodes and the lung by video-assisted thoracic surgery were necessary to confirm the presence of non-caseating granulomas. Mediastinoscopy was necessary for a lymph node biopsy in Case 5, even though EBUS-TBNA and TBLB were performed for multiple lymph nodes and the lung. Conclusion. According to the findings of this study, we were unable to identify any differences in either the medical history or clinical characteristics of these two patient groups. However, this study was a single-center study and included only 5 subjects; further studies will therefore be necessary to clarify the factors associated with an accurate diagnosis of sarcoidosis using EBUS-TBNA.
