Value of Different Bronchoscopic Sampling Techniques in Diagnosis of Sarcoidosis: A Prospective Study of 151 Patients

Goyal, Abhishek MD, DM*; Gupta, Dheeraj MD, DM, FRCP; Agarwal, Ritesh MD, DM, FRCPG; Bal, Amanjit MD; Nijhawan, Raje MD§; Aggarwal, Ashutosh N. MD, DM

Journal of Bronchology & Interventional Pulmonology: July 2014 - Volume 21 - Issue 3 - p 220–226
doi: 10.1097/LBR.0000000000000081
Original Investigations

Background: The exact position of routine bronchoscopic sampling techniques in diagnostic workup of sarcoidosis is often debated. Herein, we ascertain the role of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB), and endobronchial biopsy (EBB) in diagnosis of sarcoidosis.

Methods: Consecutive patients with suspected sarcoidosis who underwent fiberoptic bronchoscopy were studied. TBLB, EBB, TBNA, or EBUS-TBNA was performed as indicated in a standardized manner. A diagnosis of sarcoidosis was established based on the finding of non-necrotizing granulomas or on clinical grounds at 6-month follow-up. Individual and cumulative yield of various procedures and their correlation with clinicoradiologic parameters was analyzed.

Results: Of the 164 patients studied, 151 were finally diagnosed as sarcoidosis. Granulomas were demonstrated in 127 (84.2%) patients. Diagnostic yield of TBLB, EBB, TBNA, and EBUS-TBNA was 68.7%, 49.6%, 22.43%, and 57.1%, respectively. Cumulative yields of various procedures were: EBB+TBLB 81.4%; TBLB+TBNA 73.7%; TBNA+EBB 62.9%; TBLB+EBB+TBNA 86.9%; and TBLB+EBB+EBUS-TBNA 86.4%. In those with visible mucosal abnormalities, TBLB+EBB conferred the highest diagnostic yield (92.8%). Clinical findings or radiologic stage had no impact on diagnostic yield.

Conclusions: TBLB is an important tool in bronchoscopic diagnosis of sarcoidosis. If endobronchial abnormalities are seen during bronchoscopy, TBLB with EBB gives the best results otherwise TBLB combined with conventional TBNA and EBB or EBUS-TBNA are required to maximize the diagnostic yield.

*Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal

Departments of Pulmonary Medicine

Cytology

§Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Dheeraj Gupta, MD, DM, FRCP, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India (e-mail: dheeraj1910@gmail.com).

Received September 4, 2013

Accepted April 29, 2014

© 2014 by Lippincott Williams & Wilkins.