Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Sarcoidosis

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively safe and minimally invasive procedure frequently used to investigate mediastinal lymphadenopathy of unknown etiology. Due to its safety in comparison to mediastinoscopy, which is the diagnostic gold standard, EBUS-TBNA can be used as the first-line diagnostic modality for approaching mediastinal lymphadenopathy in suspected sarcoidosis. In this study, we evaluated the diagnostic yield and safety of EBUS-TBNA for sarcoidosis at our institution.
Methods: A retrospective review was performed for all patients who presented with mediastinal lymphadenopathy and underwent EBUS-TBNA for presumed sarcoidosis for a three-year period and subsequently diagnosed with sarcoidosis. Twenty-five patients were included, and parameters such as nodal station sampled, radiographic stage, adverse events, alternative diagnosis method, and symptoms were recorded.
Results: Thirteen of 25 patients had non-caseating granulomas on EBUS-TBNA with a diagnostic yield of 52%. Of 12 patients not diagnosed via EBUS-TBNA, a diagnosis was made in four patients (33%) via transbronchial lung biopsy, in three (25%) via mediastinoscopy, in one (8%) via video-assisted thoracoscopic surgery, in three (25%) with an elevated bronchoalveolar lavage (BAL) CD4/CD8 ratio and response to therapy, and in one (8%) via muscle biopsy. The average BAL CD4/CD8 ratio was 5.4 for all patients with sarcoidosis. All patients tolerated the procedure without major complications.
Conclusion: EBUS-TBNA is a useful and minimally invasive tool for the diagnosis of sarcoidosis. It should be used as the first-line diagnostic study in suspected sarcoidosis if mediastinal lymphadenopathy is present.