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Yield of EBUS-TBNA for the diagnosis of sarcoidosis: impact of operator and cytopathologist experience
  1. Asma Navasakulpong1,2,
  2. Manon Auger3 and
  3. Anne V Gonzalez1
  1. 1Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2Respiratory and Respiratory Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
  3. 3Department of Pathology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Anne V Gonzalez; anne.gonzalez{at}mcgill.ca

Abstract

Background Studies have reported a high diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of sarcoidosis. We sought to review the yield of EBUS-TBNA for the diagnosis of sarcoidosis at our institution over time, and examine factors that may influence this yield.

Methods Patients who underwent EBUS-TBNA for suspected sarcoidosis between December 2008 and November 2011 were identified. EBUS was performed without rapid on-site evaluation (ROSE) of samples. The final diagnosis was based on the results of all invasive diagnostic procedures and/or clinical follow-up. Logistic regression analysis was used to examine the effect of various factors on yield.

Results 43 patients underwent 45 EBUS-TBNA procedures for suspected sarcoidosis. A total of 115 lymph nodes were sampled. The 21 G needle was used in 51% of procedures. The mean number of lymph node stations sampled was 2.6 (SD 0.7) and the mean number of needle passes per procedure was 7.8 (SD 2.0). Non-necrotising granulomatous inflammation was detected in EBUS-TBNA samples from 34/45 (76%) procedures. The overall diagnostic yield increased to 36/45 (80%) following a cytopathology review for this study. Needle gauge, number of lymph node stations sampled and number of needle passes were not associated with diagnostic yield. The yield of EBUS-TBNA increased significantly after the first 15 procedures performed for suspected sarcoidosis; the 2 additional cases diagnosed after the cytopathology review were part of this early experience.

Conclusions EBUS-TBNA is a valuable technique for the diagnosis of sarcoidosis when performed without ROSE. The yield of the procedure improved significantly over time, based on operator and cytopathologist experience.

  • Bronchoscopy
  • Sarcoidosis
  • Histology/Cytology

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