Cell Block Examination Is Critical for Sarcoidosis Diagnosis by Endobronchial Ultrasound-Guided Mediastinal Lymph Node Fine Needle Aspiration

He Wang, MD, PhD, Akshatha Rao, MBBS, Anthony Lafranco, MD, Anil Vachani, MD, Andrew Haas, MD, PhD, Prabodh Gupta, MBBS, MD, FIAC

Abstract


Intrathoracic sarcoidosis is often diagnosed by transbronchial lung parenchymal biopsy (TBBx), however, recent studies suggest endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph node (EBUS-FNA) is safer with superior diagnostic yield. We report our experience from 2008 to 2010 with combined EBUS-FNA and TBBx in 61 consecutive patients with clinical suspicion of sarcoidosis. One to three mediastinal lymph nodes (LN) in various locations were sampled using 21/22-gauge needles with on-site interpretation. Additional one to two specimens per site were collected in Normosol® for cell block preparations. A definitive diagnosis of sarcoidosis was made in 51 patients (84%) by EBUS-FNA/TBBx studies (46) and clinical information (5); alternative diagnoses were established in 8 patients (13 %); the last 2 patients remained suspicious for sarcoidosis without confirmatory tissue diagnosis. Of the 46 biopsy (EBUS-FNA and/or TBBx) confirmed cases, 37 (80.0%) were diagnosed by EBUS-FNA. Cell blocks prepared from all 37 patients contained diagnostic material, 10 (27.0%) were interpreted as such by on-site evaluations. The diagnostic yield of LNs at different locations varied, being 100, 68, 50 and 20% in R12, subcarinal, R4, and R11, respectively. A total of 36 patients had both EBUS-FNA and TBBx performed during the same visit. Diagnoses were identical in 15 patients (42 %). TBBx independently identified 9 cases of sarcoidosis. This study indicates that cell block preparation is valuable for EBUS-FNA diagnosis of sarcoidosis. EBUS-FNA and TBBx are effective and complimentary tools for intrathoracic sarcoidosis diagnosis.

[N A J Med Sci. 2012;5(4):198-202.]


Keywords


Sarcoidosis, EBUS-FNA, cell block, mediastinal lymph node

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References


Von Bartheld MB, Veseliç-Charvat M, Rabe KF, Annema JT. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Endoscopy. 2010 42(3):213-217.

Mehrotra R, Dhingra V. Cytological diagnosis of sarcoidosis revisited: A state of the art review. Diagn. Cytopathol. 2011:39(7):541-548.

Costabel U, Ohshimo S, Guzman J. Diagnosis of sarcoidosis. Curr Opin Pulm Med. 2008;14(5):455-461.

Rosen Y . Pathology of Sarcoidosis. Semi Resp Critical Care Med. 2007;28(1):36-52.

Aisner SC, Gupta PK, Frost JK. Sputum cytology in pulmonary sarcoidosis. Acta Cytol. 1977;21(3):394-398.

Zwischenberger JB, Savage C, Alpard SK, Anderson CM, Marroquin S, Goodacre BW. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy? Chest. 2002;121(4):1165-1170.

Miliauskas S, Zemaitis M, Sakalauskas R. Sarcoidosis--moving to the new standard of diagnosis? Medicina (Kaunas). 2010;46(7):443-446.

Zaman SS, Elshami A, Gupta PK. Bronchoalveolar lavage cytology in pulmonary sarcoidosis. Acta Cytol. 1995;39 (6):1117-2312.

Zhang R, Mietchen C, Krüger M, et al. Endobronchial ultrasound guided fine needle aspiration versus transcervical mediastinoscopy in nodal staging of non small cell lung cancer: a prospective comparison study. J Cardiothorac Surg. 2012;7:51-56.

Trisolini R, Tinelli C, Cancellieri A, et al. Transbronchial needle aspiration in sarcoidosis: yield and predictors of a positive aspirate. J Thorac Cardiovasc Surg. 2008;135(4):837-842.

Oki M, Saka H, Kitagawa C, et al. Prospective study of endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes versus transbronchial lung biopsy of lung tissue for diagnosis of sarcoidosis. J Thorac Cardiovasc Surg. 2012;143(6):1324-13249.

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(2):340-346.

Cameron SE, Andrade RS, Pambuccian SE. Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology. 2010;21(1):6-26.

Schwartz LE, Aisner DL, Baloch ZW, et al. The diagnostic efficacy of combining bronchoscopic tissue biopsy and endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of malignant lesions in the lung. Diagn Cytopathol. 2012 Feb 23. doi: 10.1002/dc.22847:1-7. [Epub ahead of print]

Spagnolo P, Sato H, Grunewald J, et al. A common haplotype of the C-C chemokine receptor 2 gene and HLA-DRB1*0301 are independent genetic risk factors for Löfgren's syndrome. J Intern Med. 2008;264(5):433-41.

Michael H, Ho, S, Pollack B, Gupta M, Gress F. Diagnosis of intra-abdominal and mediastinal sarcoidosis with EUS-guided FNA. Gastrointest Endosc. 2008;67(1):28-34.

Oki M, Saka H, Kitagawa C, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology. 2007;12(6):863-868.

Iwashita T, Yasuda I, Doi S, et al. The yield of endoscopic ultrasound-guided fine needle aspiration for histological diagnosis in patients suspected of stage I sarcoidosis. Endoscopy. 2008;40(5):400-405.

Sider L, Horton ES Jr. Hilar and mediastinal adenopathy in sarcoidosis as detected by computed tomography. J Thorac Imaging. 1990;5(2):77-80.

Morgenthau AS, Iannuzzi MC. Recent advances in sarcoidosis. Chest. 2011;139(1):174-182.


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