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Benzaquen S, Matta A, Sultan S, Sarvottam K. Role of Bronchoscopy in Diagnosis of Sarcoidosis. Clin Chest Med 2024; 45:25-32. [PMID: 38245368 DOI: 10.1016/j.ccm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate the non-caseating granulomas on histopathology. This review aims to synthesize current evidence related to tissue diagnosis of sarcoidosis using various bronchoscopic techniques. We start by discussing standard bronchoscopic techniques which have remained the cornerstone of diagnostic workup such as bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), conventional transbronchial needle aspiration (cTBNA) and transbronchial lung biopsy (TBLB) followed by newer modalities that incorporate real-time image guidance using endobronchial and endoscopic ultrasound. Although BAL, EBB, and TBLB have been employed as a diagnostic tool for several decades, their sensitivity and diagnostic yield is inferior to ultrasound-based endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). More recently, convincing evidence has also emerged to support the diagnostic accuracy and tissue yield of transbronchial lung cryobiopsy which will also be discussed in this review. These advances in bronchoscopic equipment and techniques over the last 2 decades have made it possible to obtain tissue samples using minimally invasive techniques thus avoiding invasive open lung biopsy and the risks that inherently follow. Up-to-date knowledge of these modalities is imperative for ensuring evidence-based medicine and improving patient-centric outcomes.
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Affiliation(s)
- Sadia Benzaquen
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Atul Matta
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sahar Sultan
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kumar Sarvottam
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Maturu VN, Prasad VP, Vaddepally CR, Dommata RR, Sethi S. Endobronchial Ultrasound-guided Mediastinal Lymph Nodal Cryobiopsy in Patients With Nondiagnostic/Inadequate Rapid On-site Evaluation: A New Step in the Diagnostic Algorithm. J Bronchology Interv Pulmonol 2024; 31:2-12. [PMID: 36877194 DOI: 10.1097/lbr.0000000000000913] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/26/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered the investigation of choice for sampling mediastinal nodes. A major drawback of EBUS-TBNA is its lower diagnostic yield for lymphoma and benign diseases. EBUS-guided mediastinal cryobiopsy (EBUS-MCB) is a novel technique that provides larger nodal biopsy samples, with an acceptable safety profile. In this study, we aimed to evaluate the diagnostic yield of EBUS-MCB in patients with an inconclusive rapid on-site evaluation (ROSE). METHODS This is a prospective study of patients who underwent EBUS-TBNA for undiagnosed mediastinal lymphadenopathy. Patients in whom ROSE did not yield a diagnosis (nondiagnostic ROSE) or ROSE revealed scanty atypical cells (inadequate ROSE) were subjected to EBUS-MCB. The diagnostic yield, adequacy, and complications of EBUS-MCB were analyzed. RESULTS Of the 196 patients undergoing EBUS-TBNA, 46 patients underwent EBUS-MCB. Thirty-two cases underwent EBUS-MCB for a nondiagnostic ROSE. EBUS-MCB confirmed the diagnosis in 19/32 (59.3%) cases. The additive diagnostic yield of EBUS-MCB over EBUS-TBNA was 43.7% (14/32 cases). In all 14 cases where EBUS-MCB was performed for an inadequate ROSE, the material obtained by EBUS-MCB was adequate for ancillary studies. The most common complication observed was a minor bleed in 13 cases. CONCLUSION EBUS-MCB has a diagnostic yield of 59.3% when performed in cases with a nondiagnostic EBUS-ROSE. The tissue obtained by EBUS-MCB is adequate for ancillary studies. We propose EBUS-MCB as an additional diagnostic step in cases with an inconclusive ROSE while performing EBUS-TBNA. Larger studies are, however, needed before EBUS-MCB can be incorporated in the diagnostic algorithm for the evaluation of mediastinal lesions.
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Affiliation(s)
| | | | | | | | - Shweta Sethi
- Department of Pathology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, India
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Ramarmuty HY, Huan NC, Nyanti LE, Khoo TS, Renganathan T, Manoh AZ, Azman N, Sivaraman Kannan KK. Early experience of endobronchial ultrasound-guided transbronchial nodal cryobiopsy: a case series from Sabah, Malaysia. Ther Adv Respir Dis 2024; 18:17534666241231122. [PMID: 38357899 PMCID: PMC10870810 DOI: 10.1177/17534666241231122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant conditions. Continuous efforts are underway to improve the material adequacy of EBUS-TBNA, including the introduction of a new technique called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method allows for the retrieval of larger and well-preserved histologic samples from the mediastinum. We present a case series of four patients who underwent combined EBUS-TBNA and EBUS-TBNC procedures in our centre. All procedures were performed under general anaesthesia using a convex probe EBUS scope (Pentax EB-1970UK). Two patients were diagnosed with malignancy and two with benign disorders (silicosis and tuberculosis). In the malignant cases, both EBUS-TBNA/cell block and cryobiopsy provided a diagnosis but cryobiopsy yielded more material for ancillary tests in one patient. However, in the benign cases, there was discordance between EBUS-TBNA/cell block and cryobiopsy. Only cryobiopsy detected granuloma in the patient with TB (tuberculosis), and in the patient with silicosis, TBNC provided a better overall histological evaluation, leading to a definitive diagnosis. No complications were observed. This case series supports the potential diagnostic value of combining EBUS-TBNA and EBUS-TBNC, particularly in benign mediastinal lesions (granulomatous diseases), and in cases requiring additional molecular tests in cancer diagnosis.
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Affiliation(s)
- Hema Yamini Ramarmuty
- Respiratory Department, Queen Elizabeth Hospital, 13a, Jalan Penampang, Kota Kinabalu, Sabah 88200, Malaysia
| | - Nai-Chien Huan
- Respiratory Department, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Larry Ellee Nyanti
- Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Teng Shin Khoo
- Medical Department, Queen Elizabeth Hospital, Sabah, Malaysia
| | | | - Ahmad Zaki Manoh
- Department of Pathology, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Nusaibah Azman
- Department of Pathology, Queen Elizabeth Hospital, Sabah, Malaysia
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Livi V, Sivokozov I, Annema JT, Candoli P, Vasilev I, Kramer T, Ferrari M, Madan K, Fielding D, Murgu S, Cancellieri A, Semyonova LA, Puci M, Sotgiu G, Trisolini R. High-Definition Videobronchoscopy for the Diagnosis of Airway Involvement in Sarcoidosis: The Enhance Sarcoidosis Multicenter Study. Chest 2023; 164:1243-1252. [PMID: 37121391 PMCID: PMC10635836 DOI: 10.1016/j.chest.2023.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis has not been evaluated previously. RESEARCH QUESTION What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AAs)? What are the patterns of AAs more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)? STUDY DESIGN AND METHODS In this prospective international multicenter cohort study, consecutive patients with suspected sarcoidosis underwent airway inspection with an HD videobronchoscope and EBB using a standardized workflow. AAs were classified according to six patterns defined a priori: nodularity, cobblestoning, thickening, plaque, increased vascularity, and miscellaneous. We assessed diagnostic yield of EBB, prevalence of AAs, and interobserver agreement for different patterns of AAs. RESULTS AAs were identified in 64 of 134 patients with sarcoidosis (47.8%), with nodularity (n = 23 [17.2%]), plaque (n = 19 [14.2%]), and increased vascularity (n = 19 [14.2%]) being the most prevalent. The diagnostic yield of EBB was 36.6%. AAs were significantly more prevalent in patients with than in those without nonnecrotizing granulomas on EBB (67.4% vs 36.5%; P = .001). Likewise, parenchymal disease on CT scan imaging was significantly more common in patients with than in those without nonnecrotizing granulomas on EBB (79.6% vs 54.1%; P = .003). On a per-lesion analysis, nonnecrotizing granulomas were seen especially in EBB samples obtained from areas of cobblestoning (9/10 [90%]) and nodularity (17/29 [58.6%]). The overall diagnostic yield of random EBB was low (31/134 [23.1%]). The interobserver agreement for the different patterns of AA was fair (Fleiss κ = 0.34). INTERPRETATION In a population with a large prevalence of White Europeans, HD videobronchoscopy detected AAs in approximately one-half of patients with sarcoidosis. The diagnostic yield of EBB was higher in patients with parenchymal involvement on CT scan imaging and in those with AAs, especially if manifesting as cobblestoning and nodularity. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT4743596; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Vanina Livi
- Division of Interventional Pulmonology, Department of Neurosciences, Sense Organs and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Ilya Sivokozov
- Endoscopy Department, Central TB Research Institute, Moscow, Russia
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Piero Candoli
- Interventional Pulmonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Igor Vasilev
- State Research Institute of Phtisiopulmonology, St. Petersburg, Russia
| | - Tess Kramer
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marco Ferrari
- Interventional Pulmonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - David Fielding
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, The University of Chicago, Chicago, IL
| | | | - Lyudmila A Semyonova
- Department of Pathomorphology, Cell Biology and Biochemistry, Central TB Research Institute, Moscow, Russia
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Rocco Trisolini
- Division of Interventional Pulmonology, Department of Neurosciences, Sense Organs and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Hearth, Rome.
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Steinfort DP, Evison M, Witt A, Tsaknis G, Kheir F, Manners D, Madan K, Sidhu C, Fantin A, Korevaar DA, Van Der Heijden EHFM. Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement. Respirology 2023; 28:722-743. [PMID: 37463832 DOI: 10.1111/resp.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Since their introduction, both linear and radial endobronchial ultrasound (EBUS) have become an integral component of the practice of Pulmonology and Thoracic Oncology. The quality of health care can be measured by comparing the performance of an individual or a health service with an ideal threshold or benchmark. The taskforce sought to evaluate quality indicators in EBUS bronchoscopy based on clinical relevance/importance and on the basis that observed significant variation in outcomes indicates potential for improvement in health care outcomes. METHODS A comprehensive literature review informed the composition of a comprehensive list of candidate quality indicators in EBUS. A multiple-round modified Delphi consensus process was subsequently performed with the aim of reaching consensus over a final list of quality indicators and performance targets for these indicators. Standard reporting items were developed, with a strong preference for items where evidence demonstrates a relationship with quality indicator outcomes. RESULTS Twelve quality Indicators are proposed, with performance targets supported by evidence from the literature. Standardized reporting items for both radial and linear EBUS are recommended, with evidence supporting their utility in assessing procedural outcomes presented. CONCLUSION This statement is intended to provide a framework for individual proceduralists to assess the quality of EBUS they provide their patients through the identification of clinically relevant, feasible quality measures. Emphasis is placed on outcome measures, with a preference for consistent terminology to allow communication and benchmarking between centres.
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Affiliation(s)
- Daniel P Steinfort
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashleigh Witt
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Georgios Tsaknis
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, Kettering General Hospital, UK
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Manners
- St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alberto Fantin
- Department of Pulmonology, University Hospital of Udine (ASUFC), Udine, Italy
| | - Daniel A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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Choudhary R, Marwah V, Sengupta P, Malik V, Verma S, Pandey I, Kumar TA, Wasan A. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy: Experience from a tertiary care centre. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Scano V, Fois AG, Manca A, Balata F, Zinellu A, Chessa C, Pirina P, Paliogiannis P. Role of EBUS-TBNA in Non-Neoplastic Mediastinal Lymphadenopathy: Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12020512. [PMID: 35204602 PMCID: PMC8871250 DOI: 10.3390/diagnostics12020512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Mediastinal lymphadenopathy is a condition in which one or more mediastinal lymph nodes are enlarged for malignant or benign causes, generally more than 10 mm. For a long time, the only way to approach the mediastinum was surgery, while in last decades endoscopic techniques gained their role in neoplastic diseases. At the present time, EBUS is the technique of choice for studying the mediastinum in the suspicion of cancer, while there are not strong indications in guidelines for the study of benign mediastinal lymphadenopathy. We reviewed the literature, looking for evidence of the role of EBUS in the diagnostics of non-neoplastic mediastinal lymphadenopathy, with special regard for granulomatous disease, both infectious and non-infectious. EBUS is a reliable alternative to surgery in non-neoplastic mediastinal lymphadenopathy, even if more evidence is needed for granulomatous diseases other than tuberculosis and sarcoidosis.
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Affiliation(s)
- Valentina Scano
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Correspondence: ; Tel.: +39-340-926-5637
| | - Alessandro Giuseppe Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Andrea Manca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Francesca Balata
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Carla Chessa
- Postgraduate School in Hospital Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Pietro Pirina
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Panos Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
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Crombag LMM, Mooij-Kalverda K, Szlubowski A, Gnass M, Tournoy KG, Sun J, Oki M, Ninaber MK, Steinfort DP, Jennings BR, Liberman M, Bilaceroglu S, Bonta PI, Korevaar DA, Trisolini R, Annema JT. EBUS versus EUS-B for diagnosing sarcoidosis: The International Sarcoidosis Assessment (ISA) randomized clinical trial. Respirology 2021; 27:152-160. [PMID: 34792268 PMCID: PMC9299594 DOI: 10.1111/resp.14182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/15/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
Background and objective Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head‐to‐head comparison of both routes has never been performed. Methods Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)‐B‐guided nodal sampling, and to 22‐ or 25‐G ProCore needle aspiration (2 × 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow‐up at 6 months. Results A total of 358 patients were randomized: 185 patients to EBUS‐transbronchial needle aspiration (EBUS‐TBNA) and 173 to EUS‐B‐fine‐needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63–76) for EBUS‐TBNA and 68% (118/173; 95% CI, 61–75) for EUS‐B‐FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71–84) for EBUS‐TBNA and 82% (115/141; 95% CI, 74–87) for EUS‐B‐FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity. Conclusion Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS‐B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients. This global RCT in patients with suspected sarcoidosis stage I/II with an indication for endosonographic nodal sampling showed a similarly high granuloma detection rate and sensitivity for diagnosing sarcoidosis with endobronchial ultrasound versus endoscopic ultrasound‐B. The findings imply that both diagnostic tests (endobronchial/oesophageal) can be used safely and universally in suspected sarcoidosis patients.
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Affiliation(s)
- Laurence M M Crombag
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kirsten Mooij-Kalverda
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Maciej Gnass
- Endoscopy Unit, John Paul II Hospital, Kraków, Poland
| | - Kurt G Tournoy
- Department of Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Interventional Pulmonology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Maarten K Ninaber
- Department of Respiratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Barton R Jennings
- Department of Respiratory Medicine, Monash Health, Clayton, Victoria, Australia
| | - Moishe Liberman
- Division of Thoracic Surgery, University of Montreal, CR-CHUM, Montreal, Québec, Canada
| | - Semra Bilaceroglu
- Department of Respiratory Medicine, Health Sciences University, Izmir, Turkey.,Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Yenişehir Mahallesi, Izmir, Turkey
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Chrysikos S, Karampitsakos T, Zervas E, Anyfanti M, Papaioannou O, Tzouvelekis A, Hillas G, Dimakou K. Thoracic endosonography (EBUS/EUS-b) in the diagnosis of different intrathoracic diseases: A 4-year experience at a single-centre in Greece. Int J Clin Pract 2021; 75:e13684. [PMID: 32813909 DOI: 10.1111/ijcp.13684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the last decade, the advent of thoracic endosonography has revolutionised the field of diagnostic bronchoscopy. METHODS We conducted a single-centre prospective study in "Sotiria" Chest diseases hospital between January 2016 and December 2019. The study aimed to evaluate the efficacy and diagnostic value of combined EBUS/EUS-b in comparison with EBUS-TBNA and EUS-b FNA in different intrathoracic diseases. RESULTS A total of 266 patients were enrolled (70.7% males, 85.7% smokers, mean age ± SD: 62.8 ± 11.8). Diagnosis and staging of suspected lung cancer (LC) were the main indications for EBUS/EUS-b in 56.7% of patients, followed by lymphadenopathy of unknown origin in 27%, lymphadenopathy in previous malignancy in 10.9%, and staging of proven LC in 5.3%. EUS-b FNA alone or combined with EBUS-TBNA was performed in 14.7% of patients. A total of 512 lymph nodes was sampled (481 through EBUS-TBNA and 31 through EUS-b FNA). EBUS/EUS-b led to a definitive diagnosis in 68.4% of the patients. Most cases (50.4%) were malignancies, while 18% represented benign diseases (83.3% sarcoidosis). Sensitivity of combined EBUS/EUS-b was higher in comparison with sensitivity of both procedures alone (100% vs 89.4% vs 88.9%). Accordingly, the overall sensitivity of EBUS/EUS-b for the detection of malignancy and sarcoidosis was 93% and 95.2%, respectively. No severe complications were observed. CONCLUSION Thoracic endosonography is an efficient, safe, minimally invasive tool yielding high sensitivity and diagnostic accuracy in patients with suspected malignancy and mediastinal lymphadenopathy. Experienced pulmonologists in EBUS-TBNA should more routinely perform EUS-b FNA to avoid unnecessary surgical interventions.
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Affiliation(s)
- Serafeim Chrysikos
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | | | - Eleftherios Zervas
- 7th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Maria Anyfanti
- Intensive Care Unit, Georgios Gennimatas General Hospital, Athens, Greece
| | - Ourania Papaioannou
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Argyrios Tzouvelekis
- 1st Academic Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Hillas
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
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Cheng WC, Shen MF, Wu BR, Liao WC, Chen CY, Chen WC, Chen CH, Tu CY. Identification of Specific Endobronchial Ultrasound Features to Differentiate Sarcoidosis From Other Causes of Lymphadenopathy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:49-58. [PMID: 32562435 DOI: 10.1002/jum.15372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We hypothesized that specific endobronchial ultrasound (EBUS) features may differentiate sarcoidosis from other causes of lymphadenopathy. METHODS We conducted this retrospective observational study from January 2014 to January 2019 to analyze patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration. Ultrasound features, including nodal size, margin, echogenicity, the presence or absence of calcification, a central hilar structure, the coagulation necrosis sign, nodal conglomeration, and the septal vessel sign in the color Doppler mode were recorded and compared between 3 groups. RESULTS Of the 90 included patients, 15 had a diagnosis of tuberculosis; 56 had a diagnosis of sarcoidosis; and 19 had a diagnosis of malignant lymph nodes by EBUS-guided transbronchial needle aspiration. The presence of nodal conglomeration (94.6% versus 60.0% versus 5.3%; P < .001), the septal vessel sign in the color Doppler mode (55.4% versus 13.3% versus 15.8%; P = .002), and a distinct margin (73.2% versus 13.3% versus 47.4%; P < .001) were significantly higher in the sarcoidosis group than in the tuberculosis lymphadenopathy and malignant lymph node groups. The presence of the coagulation necrosis sign (8.9% versus 93.3% versus 31.6%; P < .001) was significantly lower in the sarcoidosis group than in tuberculosis lymphadenopathy and malignant lymph node groups. A multivariate analysis showed that the presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode were independent predictive factors for the diagnosis of sarcoidosis. CONCLUSIONS The presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode in lymph nodes on EBUS are predictive of sarcoidosis.
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Affiliation(s)
- Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University, Taichung, Taiwan
| | - Meng-Fang Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Biing-Ru Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University, Taichung, Taiwan
| | - Chih-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University, Taichung, Taiwan
- Taiwan Clinical Trial Consortium for Lung Diseases, Taipei, Taiwan
| | - Wei-Chun Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University, Taichung, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yen Tu
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
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11
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Carbonari A, Rossini L, Marioni F, Camunha M, Saieg M, Bernardi F, Maluf F, Botter M, Dorgan V, Saad R. Value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of lung and mediastinal lesions. ACTA ACUST UNITED AC 2020; 66:1210-1216. [PMID: 33027447 DOI: 10.1590/1806-9282.66.9.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the value of EBUS-TBNA in the diagnosis of lung and mediastinal lesions. METHODS Prospective cohort study that included 52 patients during a 2-year period (2016 to 2018) who underwent EBUS-TBNA. RESULTS Among the 52 individuals submitted to the procedure, 22 (42.31%) patients were diagnosed with locally advanced lung cancer (N2 or N3 lymph node involvement). EBUS-TBNA confirmed the diagnosis of metastases from other extrathoracic tumors in the mediastinum or lung in 5 patients (9.61%), confirmed small cell lung cancer in 3 patients (5.76%), mediastinal sarcoidosis in 1 patient (1.92%), and reactive mediastinal lymph node in 8 patients (15.38%); insufficient results were found for 3 patients (5.76%). Based on these results, EBUS-TBNA avoided further subsequent surgical procedures in 39 of 52 patients (75%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 100%, 100%, 77%, and 90%, respectively. No major complications were observed. CONCLUSIONS EBUS-TBNA is a safe, effective, and valuable method. This technique can significantly reduce the rate of subsequent surgical procedures required for the diagnosis of lung and mediastinal lesions.
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Affiliation(s)
- Augusto Carbonari
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Lucio Rossini
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Fabio Marioni
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Marco Camunha
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Mauro Saieg
- Hospital Santa Casa de São Paulo - Departamento de Patologia, São Paulo, SP, Brasil
| | - Fabiola Bernardi
- Hospital Santa Casa de São Paulo - Departamento de Patologia, São Paulo, SP, Brasil
| | - Fernando Maluf
- Hospital Santa Casa de São Paulo - Departamento de Oncologia, São Paulo, SP, Brasil
| | - Marcio Botter
- Hospital Santa Casa de São Paulo - Departamento de Cirurgia Toráxica, São Paulo, SP, Brasil
| | - Vicente Dorgan
- Hospital Santa Casa de São Paulo - Departamento de Cirurgia Toráxica, São Paulo, SP, Brasil
| | - Roberto Saad
- Hospital Santa Casa de São Paulo - Departamento de Cirurgia Toráxica, São Paulo, SP, Brasil
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12
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Trisolini R, Verhoeven RLJ, Cancellieri A, De Silvestri A, Natali F, Van der Heijden EHFM. Role of endobronchial ultrasound strain elastography in the identification of fibrotic lymph nodes in sarcoidosis: A pilot study. Respirology 2020; 25:1203-1206. [PMID: 32656895 DOI: 10.1111/resp.13900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica, Roma, Italy.,Interventional Pulmonology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola, Bologna, Italy
| | - Roel L J Verhoeven
- Department of Pulmonology, Radboudumc, Nijmegen, The Netherlands.,Department of Radiology, Radboudumc, Nijmegen, The Netherlands
| | - Alessandra Cancellieri
- Pathology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica, Roma, Italy.,Pathology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola, Bologna, Italy
| | | | - Filippo Natali
- Interventional Pulmonology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola, Bologna, Italy
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13
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Mondoni M, Rinaldo RF, Carlucci P, Terraneo S, Saderi L, Centanni S, Sotgiu G. Bronchoscopic sampling techniques in the era of technological bronchoscopy. Pulmonology 2020; 28:461-471. [PMID: 32624385 DOI: 10.1016/j.pulmoe.2020.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Flexible bronchoscopy is a key diagnostic and therapeutic tool. New endoscopes and technologically advanced navigational modalities have been recently introduced on the market and in clinical practice, mainly for the diagnosis of mediastinal lymph adenopathies and peripheral lung nodules. Bronchoscopic sampling tools have not changed significantly in the last three decades, with the sole exception of cryobiopsy. We carried out a non-systematic, narrative literature review aimed at summarizing the scientific evidence on the main indications/contraindications, diagnostic yield, and safety of the available bronchoscopic sampling techniques. Performance of bronchoalveolar lavage, bronchial washing, brushing, forceps biopsy, cryobiopsy and needle aspiration techniques are described, focusing on indications and diagnostic accuracy in the work-up of endobronchial lesions, peripheral pulmonary abnormalities, interstitial lung diseases, and/or hilar-mediastinal lymph adenopathies. Main factors affecting the diagnostic yield and the navigational methods are evaluated. Preliminary data on the utility of the newest sampling techniques (i.e., new needles, triple cytology needle brush, core biopsy system, and cautery-assisted transbronchial forceps biopsy) are shown. TAKE HOME MESSAGE: A deep knowledge of bronchoscopic sampling techniques is crucial in the era of technological bronchoscopy for an optimal management of respiratory diseases.
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Affiliation(s)
- M Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - R F Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - P Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - S Terraneo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - S Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy.
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14
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Balwan A. Three-Year Experience With the 19-Gauge Endobronchial Ultrasound Needle: A Sarcoidosis Perspective. Arch Bronconeumol 2020; 56:405-406. [PMID: 35373753 DOI: 10.1016/j.arbr.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/24/2019] [Indexed: 06/14/2023]
Affiliation(s)
- Akshu Balwan
- Division of Pulmonary and Critical Care, ME, United States.
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15
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Three-Year Experience With the 19-Gauge Endobronchial Ultrasound Needle: A Sarcoidosis Perspective. Arch Bronconeumol 2020. [PMID: 32037103 DOI: 10.1016/j.arbres.2019.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Mehta RM, Aurangabadbadwalla R, Singla A, Loknath C, Munavvar M. Endobronchial ultrasound-guided mediastinal lymph node forceps biopsy in patients with negative rapid-on-site-evaluation: A new step in the diagnostic algorithm. CLINICAL RESPIRATORY JOURNAL 2019; 14:314-319. [PMID: 31845474 DOI: 10.1111/crj.13133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/07/2019] [Accepted: 12/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) provides a high diagnostic yield in lung cancer, but the yield for benign conditions and lymphoma is lower. The material obtained by EBUS-TBNA is limited by the lack of histopathological samples in some cases. The current 'expanded' aims of mediastinal lymph node (MLN) sampling are both an accurate diagnosis and adequate material for 'targeted' processing in malignant and benign disease. The sample obtained with the 21/22G EBUS needle may not be sufficient in all situations. OBJECTIVES The aim of the study was to evaluate the role of a novel technique for EBUS-guided MLN forceps biopsy (EBUS-TBFB) when EBUS-TBNA with rapid on-site-evaluation (ROSE) failed to provide a diagnosis. In addition, the technical aspects and safety of EBUS-TBFB were studied. METHODS About 30 consecutive patients with enlarged MLN, with a negative EBUS-TBNA ROSE were included. EBUS-TBFB was done by the method described below. The histopathology and complications were recorded. RESULTS Adequate samples for analysis were obtained in all the patients with both EBUS-TBNA and EBUS-TBFB. In patients with a non-diagnostic EBUS-ROSE, EBUS-TBFB led to positive diagnostic results in an additional 8/30 patients (27%). Mild bleeding was noted in two patients who underwent EBUS-TBFB, which resolved with conservative management. The procedure was safe with no major complications. CONCLUSION In patients with a negative EBUS-ROSE, EBUS-TBFB using this technique is safe and augments the diagnostic yield. EBUS-TBFB adds to the armamentarium of EBUS, especially in benign aetiologies of MLN enlargement.
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Affiliation(s)
- Ravindra M Mehta
- Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bangalore, India
| | | | - Abhinav Singla
- Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bangalore, India
| | - Chakravarthi Loknath
- Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bangalore, India
| | - Mohammed Munavvar
- Department of Pulmonology, Lancashire Teaching Hospitals, Preston, United Kingdom
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17
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Livi V, Cancellieri A, Pirina P, Fois A, van der Heijden EHFM, Trisolini R. Endobronchial Ultrasound Elastography Helps Identify Fibrotic Lymph Nodes in Sarcoidosis. Am J Respir Crit Care Med 2019; 199:e24-e25. [PMID: 30207738 DOI: 10.1164/rccm.201710-2004im] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vanina Livi
- 1 Interventional Pulmonology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola, Bologna, Italy
| | - Alessandra Cancellieri
- 2 Pathology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola & Ospedale Maggiore, Bologna, Italy
| | - Pietro Pirina
- 3 Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria, Sassari, Italy; and
| | - Alessandro Fois
- 3 Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria, Sassari, Italy; and
| | | | - Rocco Trisolini
- 1 Interventional Pulmonology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola, Bologna, Italy
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18
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Burks AC, Vece T, Akulian J. Should endoscopic ultrasound-guided biopsies for mediastinal abnormalities be performed by pediatric pulmonologists? Pediatr Pulmonol 2019; 54:1647-1649. [PMID: 31411381 DOI: 10.1002/ppul.24472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022]
Affiliation(s)
- A Cole Burks
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy Vece
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason Akulian
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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19
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Jacob M, Bastos HN, Mota PC, Melo N, Cunha R, Pereira JM, Guimarães S, Souto Moura C, Morais A. Diagnostic yield and safety of transbronchial cryobiopsy in sarcoidosis. ERJ Open Res 2019; 5:00203-2019. [PMID: 31649951 PMCID: PMC6801217 DOI: 10.1183/23120541.00203-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Transbronchial lung cryobiopsy (TBLC) is an endoscopic technique proven to be useful in diagnostic approach to interstitial lung disease (ILD), but its role in sarcoidosis is not fully established. The aim of the present study was to assess the diagnostic yield of TBLC in sarcoidosis and its safety profile. Methods Retrospective analysis of patients, evaluated in a tertiary hospital ILD outpatient clinic, who underwent TBLC in the diagnostic work-up. TBLC was performed in accordance with the 2018 expert statement from the Cryobiopsy Working Group. Results 32 patients were included (mean±sd age 47.7±12.6 years, 59.4% male) and divided into three groups: highly likely sarcoidosis (n=21), possible sarcoidosis (n=6) and unlikely sarcoidosis (n=5). A mean of 2.8±0.8 TBLCs were performed. The definitive diagnosis was established by TBLC in 20 out of 27 patients with suspected sarcoidosis. Two patients were diagnosed with sarcoidosis by other methods performed afterwards. TBLC leaded to other diagnosis as well, such as fungal infection (n=1), hypersensitivity pneumonitis (n=1) and silicosis (n=3), making the diagnostic yield for suspected sarcoidosis of TBLC of 92.6%. TBLC was also able to show compatible histological features in five patients whom sarcoidosis was not previously considered. The complications reported overall were pneumothorax in five (15.6%) patients and moderate bleeding in one (3.1%) case. Conclusion In this cohort, TBLC was a safe, reliable and useful procedure in sarcoidosis diagnosis. These results suggest that TBLC can be used successfully in those cases where a definitive diagnosis could not be reached with the usual and less-invasive diagnostic tools. TBLC is a safe procedure with a high diagnostic yield in patients with a prior suspicion of sarcoidosis. Moreover, it can diagnose atypical cases in which previous methods are inconclusive.http://bit.ly/2KWJxLG
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Affiliation(s)
- Maria Jacob
- Pulmonology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Hélder Novais Bastos
- Pulmonology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal.,IBMC/i3S - Institute for Molecular and Cell Biology/Institute for Research and Innovation in Health, Porto, Portugal
| | - Patrícia Caetano Mota
- Pulmonology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - Natália Melo
- Pulmonology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rui Cunha
- Faculty of Medicine of Porto University, Porto, Portugal.,Radiology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Miguel Pereira
- Faculty of Medicine of Porto University, Porto, Portugal.,Radiology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Guimarães
- Faculty of Medicine of Porto University, Porto, Portugal.,Pathology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Conceição Souto Moura
- Faculty of Medicine of Porto University, Porto, Portugal.,Pathology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Morais
- Pulmonology Dept, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal.,IBMC/i3S - Institute for Molecular and Cell Biology/Institute for Research and Innovation in Health, Porto, Portugal
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20
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Pedro C, Melo N, Novais E Bastos H, Magalhães A, Fernandes G, Martins N, Morais A, Caetano Mota P. Role of Bronchoscopic Techniques in the Diagnosis of Thoracic Sarcoidosis. J Clin Med 2019; 8:E1327. [PMID: 31466346 PMCID: PMC6780968 DOI: 10.3390/jcm8091327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/04/2019] [Accepted: 08/26/2019] [Indexed: 01/09/2023] Open
Abstract
The diagnosis of sarcoidosis relies on clinical and radiological presentation, evidence of non-caseating granulomas in histopathology and exclusion of alternative causes of granulomatous inflammation. Currently, a proper diagnosis, with a high level of confidence, is considered as key to the appropriate diagnosis and management of the disease. In this sense, this review aims to provide a brief overview on the role of bronchoscopy in the diagnosis of thoracic sarcoidosis, incorporating newer techniques to establish, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), transesophageal ultrasound-guided needle aspiration with the use of an echo bronchoscope (EUS-B-FNA) and transbronchial lung cryobiopsy (TBLC). Most of the literature reports the diagnostic superiority of endosonographic techniques, such as EBUS-TBNA alone or in combination with EUS-FNA, over conventional bronchoscopic modalities in diagnosing Scadding stages I and II of the disease. Moreover, TBLC may be considered a useful and safe diagnostic tool for thoracic sarcoidosis, overcoming some limitations of transbronchial lung biopsy (TBLB), avoiding more invasive modalities and being complementary to endosonographic procedures such as EBUS-TBNA.
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Affiliation(s)
- Cecília Pedro
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Natália Melo
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Hélder Novais E Bastos
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-319 Porto, Portugal
| | - Adriana Magalhães
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Gabriela Fernandes
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-319 Porto, Portugal
| | - António Morais
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Patrícia Caetano Mota
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
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21
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Bailey N, Krisnadi Z, Kaur R, Mulrennan S, Phillips M, Slavova-Azmanova N. A pragmatic application of endobronchial ultrasound-guided transbronchial needle aspiration: a single institution experience. BMC Pulm Med 2019; 19:155. [PMID: 31429741 PMCID: PMC6701134 DOI: 10.1186/s12890-019-0909-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background Endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) is minimally invasive technique used for diagnosis and/or staging of benign and malignant pulmonary and non-pulmonary disease. Previous studies have established the utility of EBUS-TBNA in narrowly defined indications and populations. In this pragmatic ‘real world’ study we have analysed the use of EBUS-TBNA for a variety of clinical presentations and its clinical application in conjunction with other invasive investigations. Methods All EBUS-TBNA procedures performed at Sir Charles Gardiner Hospital in 2012–2014 were reviewed retrospectively, using relevant hospital databases. Results A total of 327 patients underwent 337 EBUS-TBNA procedures. EBUS-TBNA procedures were used to diagnose a wide spectrum of benign and malignant conditions. The main application was in the diagnosis and staging of malignant conditions (70.6%), and in the diagnosis of benign conditions such as sarcoidosis 40 (12.2%), and silicoanthracosis 17 (5.2%). EBUS-TBNA was sufficient to diagnose and stage the disease as a single stand-alone invasive procedure in 191 (59.2%) patients. EBUS-TBNA was the final invasive procedure undertaken in 283 (87.6%) patients. Only 13.3% of non small cell lung cancer (NSCLC) patients who had EBUS-TBNA as a first investigation required multiple procedures compared to 51.1% of all NSCLC patients undergoing EBUS-TBNA. Overall sensitivity, specificity, NPV and diagnostic accuracy for EBUS-TBNA were 89.7, 100, 85.1 and 89.9%, respectively and three minor complications (0.9%) occurred as a result of the procedure. Conclusions EBUS-TBNA was undertaken for a wide variety of clinical conditions. Good diagnostic accuracy and safety profiles were demonstrated for the procedure, supporting its application as a first line investigation in the diagnosis and/or staging of a range of malignant and benign conditions. Our study was unique in its documentation of the use of EBUS-TBNA in a real-world setting in conjunction with other invasive modalities. EBUS-TBNA was utilised as a stand alone invasive procedure in more than half of the patients. Importantly, in NSCLC, when EBUS-TBNA was performed as primary diagnostic and staging investigation, less patients underwent subsequent invasive procedures.
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Affiliation(s)
- Nicola Bailey
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Medicine, The University of Western Australia, M581, 35 Stirling Hwy, Crawley, 6009, Australia
| | - Zoe Krisnadi
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Medicine, The University of Western Australia, M581, 35 Stirling Hwy, Crawley, 6009, Australia
| | - Raena Kaur
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Medicine, The University of Western Australia, M581, 35 Stirling Hwy, Crawley, 6009, Australia
| | - Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, 1 Hospital Avenue, Nedlands, 6009, Australia.,School of Medicine and Pharmacology, The University of Western Australia, M507, 35 Stirling Hwy, Crawley, 6009, Australia
| | - Martin Phillips
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, 1 Hospital Avenue, Nedlands, 6009, Australia
| | - Neli Slavova-Azmanova
- Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), School of Medicine, The University of Western Australia, M581, 35 Stirling Hwy, Crawley, 6009, Australia.
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Role of Convex Probe Endobronchial Ultrasound in the Diagnosis and Treatment of Nonmalignant Diseases. Pulm Med 2019; 2019:6838439. [PMID: 31316830 PMCID: PMC6601475 DOI: 10.1155/2019/6838439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 01/08/2023] Open
Abstract
Here we present a comprehensive review of the literature concerning the utility of convex probe endobronchial ultrasound (CP-EBUS) in the diagnosis and treatment of nonmalignant conditions and discuss the associated complications. CP-EBUS has been conventionally used for the staging of lung cancer and sampling of mediastinal and hilar nodes. However, its application is not limited to malignant conditions, and it is gaining acceptance as a diagnostic modality of choice for nonmalignant conditions such as tuberculosis, sarcoidosis, pulmonary embolism, thyroid lesions, and cysts. Moreover, its therapeutic value allows for extended applications such as mediastinal and thyroid cyst drainage, fiducial marker placement for radiation therapy, and transbronchial needle injection. The noninvasiveness, low complication rate, high diagnostic yield, and satisfactory sensitivity and specificity values are the main attributes that lend credence to the use of CP-EBUS as a standalone primary diagnostic and therapeutic tool in pulmonary medicine in the foreseeable future.
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Trisolini R, Baughman RP, Spagnolo P, Culver DA. Endobronchial ultrasound-guided transbronchial needle aspiration in sarcoidosis: Beyond the diagnostic yield. Respirology 2019; 24:531-542. [PMID: 30912244 DOI: 10.1111/resp.13537] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 01/06/2023]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the commonly used technique for pathological confirmation of clinically suspected sarcoidosis, mostly owing to its consistently high success rate in the detection of granulomas. However, other possible advantages, which are less appreciated and often poorly studied, may also contribute to the wider use of EBUS-TBNA in the future. These advantages include refinement of differential diagnoses through the study of lymph node characteristics during B-mode examination; reduction of complications associated with bronchoscopy, as well as improved triage of the specimen for ancillary studies with the use of rapid on-site evaluation; optimization of the quality of the sample through the selection of a target area for biopsy with minimal vascularity and absence of calcifications by using the colour Doppler and the B-mode; and prediction of the presence of extensive lymph node fibrosis by using the strain elastography module. Yet, limitations and possible clinical drawbacks should also be acknowledged. Indeed, due to the lack of specificity of the pathology findings in EBUS-derived samples, the diagnosis of sarcoidosis is one of the exclusion and should remain essentially clinical. The external validity of EBUS-TBNA results in sarcoidosis is questionable, as they mainly derive from studies in populations with a high disease prevalence. Finally, the risk exists that the low morbidity and high diagnostic yield of EBUS-TBNA may lead to its overuse in patients with clinical/radiological findings specific enough to secure a clinical diagnosis of sarcoidosis.
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Affiliation(s)
- Rocco Trisolini
- Interventional Pulmonology Unit, Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Paolo Spagnolo
- Section of Respiratory Diseases, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniel A Culver
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
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Santosa A, Wong CF, Koh LW. Multisystemic sarcoidosis-important lessons learnt from one of the great imitators. BMJ Case Rep 2019; 12:e227929. [PMID: 30904884 PMCID: PMC6453389 DOI: 10.1136/bcr-2018-227929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.
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Affiliation(s)
- Anindita Santosa
- Medicine (Rheumatology), Changi General Hospital, Singapore, Singapore, Singapore
| | | | - Li Wearn Koh
- Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
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Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Using 19-G Needle for Sarcoidosis. J Bronchology Interv Pulmonol 2018; 25:260-263. [PMID: 29771778 DOI: 10.1097/lbr.0000000000000502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Flexible bronchoscopy with endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is increasingly being used to obtain pathology specimens for diagnosis of sarcoidosis. There is wide variation in reported diagnostic yield in literature. New TBNA needles are available in the market but data are lacking about their diagnostic yield especially for sarcoidosis. This study reports the diagnostic yield of bronchoscopy with EBUS-TBNA using ViziShot FLEX 19-G needle in a series of patients with suspected sarcoidosis. METHODS This is a retrospective chart review for diagnostic yield of the 19-G EBUS-TBNA needle for suspected sarcoidosis. RESULTS Eighty-six EBUS bronchoscopies were performed, 15 were done with clinical suspicion of sarcoidosis. The 19-G needle was used for all cases of suspected sarcoidosis. The procedure was diagnostic of sarcoidosis in 14 (93.3%) patients by TBNA with 1 nondiagnostic bronchoscopy. Procedural diagnostic yield was 93.3%. Eighty-five percent (28/33) of sampled lymph nodes were positive for noncaseating granulomas. The yield of transbronchial lung biopsy (TBLB) and endobronchial lung biopsy was 38% (5/13) and 43% (6/14), respectively. TBLB and endobronchial lung biopsy did not add to the diagnostic yield of the procedure. No significant adverse events were noted. CONCLUSION This series reports a higher diagnostic yield than most other published studies and opens platform for direct comparison of each available needle. It also adds to the safety data for this larger needle. In addition, it raises doubt into utility of TBLB for diagnosis of sarcoidosis, which can increase the procedural complications.
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26
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Akao K, Minezawa T, Yamamoto N, Okamura T, Inoue T, Yamatsuta K, Uozu S, Goto Y, Hayashi M, Isogai S, Kondo M, Imaizumi K. Flow cytometric analysis of lymphocyte profiles in mediastinal lymphadenopathy of sarcoidosis. PLoS One 2018; 13:e0206972. [PMID: 30452447 PMCID: PMC6242308 DOI: 10.1371/journal.pone.0206972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/23/2018] [Indexed: 12/25/2022] Open
Abstract
Lymphocyte profiles in mediastinal lymph nodes may reflect the immune status of patients with sarcoidosis. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for the diagnosis of diseases with mediastinal lymphadenopathy including sarcoidosis. The purpose of this study was to determine lymphocyte profiles of lymph nodes in sarcoidosis by analyzing EBUS-TBNA samples. We prepared single cell suspensions from EBUS-TBNA samples of mediastinal lymph nodes from patients with sarcoidosis or lung cancer and analyzed surface markers (CD3, CD4, CD8, CD19, CD25) and FoxP3 expression in the resultant lymphocytes using flow cytometry. We studied 26 patients with sarcoidosis and 16 with lung cancer with mediastinal lymph node metastases. In sarcoidosis, the CD4/CD8 ratio was significantly more elevated in lymph nodes than in bronchoalveolar lavage fluid (P<0.001), although both were strongly correlated. The CD4/CD8 ratio was significantly higher in stage I than in stage II both in the BAL fluid and lymph nodes. When compared with lung cancer lymph node metastasis, the CD4/CD8 ratio was significantly higher in sarcoidosis, whereas the CD3/CD19 ratio was significantly higher in lung cancer. The proportion of regulatory T cells (CD4+, CD25+, FoxP3 high) did not differ between sarcoidosis and lung cancer samples. Lymphocyte profiles in mediastinal lymphadenopathy can be analyzed by flow cytometry of EBUS-TBNA samples. These findings might help elucidate the immunopathology of sarcoidosis.
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Affiliation(s)
- Ken Akao
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tomoyuki Minezawa
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Naoki Yamamoto
- Regenerative Medicine Support Promotion Facility, Center for Research Promotion and Support, Fujita Health University, Toyoake, Aichi, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Inoue
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kumiko Yamatsuta
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sakurako Uozu
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masamichi Hayashi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sumito Isogai
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masashi Kondo
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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27
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Pulmonary Sarcoidosis Considerations in Primary Care. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, Wells AU. Pulmonary sarcoidosis. THE LANCET RESPIRATORY MEDICINE 2018; 6:389-402. [DOI: 10.1016/s2213-2600(18)30064-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 12/14/2022]
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Benzaquen S, Aragaki-Nakahodo AA. Bronchoscopic modalities to diagnose sarcoidosis. Curr Opin Pulm Med 2018; 23:433-438. [PMID: 28590291 DOI: 10.1097/mcp.0000000000000398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Several studies have investigated different bronchoscopic techniques to obtain tissue diagnosis in patients with suspected sarcoidosis when the diagnosis cannot be based on clinicoradiographic findings alone. In this review, we will describe the most recent and relevant evidence from different bronchoscopic modalities to diagnose sarcoidosis. RECENT FINDINGS Despite multiple available bronchoscopic modalities to procure tissue samples to diagnose sarcoidosis, the vast majority of evidence favors endobronchial ultrasound transbronchial needle aspiration to diagnose Scadding stages 1 and 2 sarcoidosis. Transbronchial lung cryobiopsy is a new technique that is mainly used to aid in the diagnosis of undifferentiated interstitial lung disease; however, we will discuss its potential use in sarcoidosis. SUMMARY This review illustrates the limited information about the different bronchoscopic techniques to aid in the diagnosis of pulmonary sarcoidosis. However, it demonstrates that the combination of available bronchoscopic techniques increases the diagnostic yield for suspected sarcoidosis.
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Affiliation(s)
- Sadia Benzaquen
- Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Cincinnati, Ohio, USA
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Bediwy AS, Zamzam K, Hantira M, El-Sharawy D, ElSaqa A, Zamzam Y. The value of rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_20_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Ohshimo S, Guzman J, Costabel U, Bonella F. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Eur Respir Rev 2017; 26:26/145/170012. [PMID: 28794143 PMCID: PMC9488688 DOI: 10.1183/16000617.0012-2017] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/25/2017] [Indexed: 01/11/2023] Open
Abstract
Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis. A multidisciplinary approach is crucial for the accurate differential diagnosis of granulomatous lung diseaseshttp://ow.ly/FxsP30cebtf
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Abstract
Sarcoidosis is a rare granulomatous disease mainly affecting lymph nodes and the lungs but joints, bones, muscles and other organs can also be affected. Sarcoidosis therefore represents an important differential diagnosis to various rheumatic diseases. For the diagnosis and differential diagnostic clarification, bronchoscopy including endobronchial ultrasound-guided fine needle aspiration of mediastinal and hilar lymph nodes represent the main procedures. Because of the high spontaneous remission rate initiating a therapy requires a therapeutic goal defined by sarcoidosis-associated functional organ impairment, especially for acute sarcoidosis. Cortisone represents the most commonly administered medication whereas methotrexate and azathioprine are well-established second-line medications. Antibodies which neutralize tumor necrosis factors (TNF) are a potential third-line therapy.
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Jeebun V, Harrison RN. Understanding local performance data for EBUS-TBNA: insights from an unselected case series at a high volume UK center. J Thorac Dis 2017; 9:S350-S362. [PMID: 28603645 DOI: 10.21037/jtd.2017.05.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We reviewed the diagnostic performance of endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) on an unselected large cohort of patients who underwent the procedure in our institution in the past 3 years and to compare against published standards and existing literature. METHODS All consecutive patients who underwent EBUS from January 2013 to December 2015 were included in the retrospective analysis, with a minimum of 6 months of clinico-radiological follow up. For assessing EBUS-TBNA performance, patients were analysed in three subgroups based on the indication for the EBUS-TBNA: in investigation of isolated mediastinal and/or hilar lymphadenopathy (IMHL), in staging of suspected or confirmed non-small cell lung cancer (NSCLC) and in making a tissue diagnosis in suspected thoracic or extrathoracic cancer. For patients subjected to EBUS-TBNA for staging in suspected lung cancer, accuracy of EBUS was measured by its ability to determine the true N2 stage. RESULTS A total of 1,656 lymph nodes and 138 peribronchial/peritracheal masses were sampled in 940 patients over the study period. The prevalence of reactive lymphadenopathy was 34%. The overall sensitivity to detect pathological disease was 81.6% (95% CI: 74.2-87.6%) whilst NPV was 74.8% (95% CI: 65.2-82.8%). Amongst patients who underwent EBUS-TBNA for staging purposes, the sensitivity for N2 staging was 83.7% (95% CI: 76.2-89.6%) and NPV was 81.6% (95% CI: 73.2-88.2%). The prevalence of N2 disease was 58%. In the subgroup of patients who proceeded to surgical sampling, the sensitivity was higher with the N2/N3 disease prevalence of 67.4%. The sensitivity of EBUS-TBNA to make a tissue diagnosis of thoracic or extrathoracic cancer was 88% (95% CI: 85.1-90.5%) and a NPV of 62% (95% CI: 54.7-69.0%). The disease prevalence was 83.6%. CONCLUSIONS This retrospective study of a large volume of patients represents real life practice and provides an accurate representation of the typical cohort of patients referred in for EBUS-TBNA to the general respiratory physician in UK. Our study highlights the pitfalls in collecting and analyzing data but also demonstrates how they can be used to improve service performance.
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Affiliation(s)
- Vandana Jeebun
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
| | - Richard Neil Harrison
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
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[Sarcoidosis and uveitis : An update]. Ophthalmologe 2016; 114:525-533. [PMID: 27904945 DOI: 10.1007/s00347-016-0405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ocular involvement in sarcoidosis is present in up to one third of patients and is frequently manifested before the underlying systemic disease has been diagnosed. With a view to the therapeutic consequences an early diagnosis of the underlying disease is advantageous. In cases of visual loss early diagnostic measures include invasive procedures, such as ultrasound-guided bronchoalveolar lavage and transbronchial biopsy, if nodular conjunctival or cutaneous manifestations which would confirm the diagnosis are not present. Sufficiently sensitive biomarkers of disease activity have not yet been identified. As elevated activity of angiotensin-converting enzyme (ACE) and lysozyme are associated with disease activity they may be supportive of but not specific for the diagnosis. Other indicators include calcemia, calciuria, augmented activity of hepatic enzymes, cutaneous anergy and hilar changes in the lungs. In patients with newly diagnosed anterior uveitis presenting with granulomatous mutton-fat corneal precipitates, snow balls and vitreous body base condensates with mild retinal periphlebitis in intermediate uveitis as well as multifocal choroiditis (creamy choroidal lesions at different stages of activity and approximately 500 µm in diameter), a diagnosis of sarcoidosis has to be considered and tuberculosis should be excluded, even in the absence of a known systemic disease. Anterior uveitis is frequently a self-limiting condition, which can be well-controlled with topical steroids. On the other hand, intermediate, posterior and panuveitis are typically associated with a chronic course and require systemic therapy to prevent severe loss of vision. If the response to systemic corticosteroids is insufficient, treatment with immunomodulatory agents and biologics is initiated at progressively earlier stages, with a view to averting permanent organ damage and frequently with a positive impact on the short and long-term outcomes, even in therapy-refractive cases.
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Chen YB, Jiang JH, Mao JY, Huang JA. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions: Six cases reports and review of literature. Medicine (Baltimore) 2016; 95:e5249. [PMID: 27858883 PMCID: PMC5591131 DOI: 10.1097/md.0000000000005249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with isolated mediastinal or hilar lymphadenopathy, or peribronchial lesions, are common presentation to clinicians. Due to the difficulty in tissue sampling, the pathological diagnosis is not so easy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established, highly effective, minimally invasive technique for sampling. The current study was conducted to investigate the value of EBUS-TBNA in patients of solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions. METHODS Six patients with different pathological results diagnosed via EBUS-TBNA were retrospectively analyzed in this study. RESULTS All 6 patients of solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions underwent conventional flexible bronchoscopy before EBUS-TBNA, but only EBUS-TBNA was helpful for the finally definite diagnosis. No complication was observed. CONCLUSION EBUS-TBNA is a safe and highly effective diagnostic procedure for both benign and malignant diseases, especially for patients with solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions.
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Affiliation(s)
| | | | | | - Jian-An Huang
- Department of Respiratory Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Jian-An Huang, Department of Respiratory Medicine, the First Affiliated Hospital of Soochow University, 899#, Pinghai road, Suzhou 215000, China (e-mail: )
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Yan JH, Pan L, Chen XL, Chen JW, Yan LM, Liu B, Guo YZ. Endobronchial ultrasound versus conventional transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: a meta-analysis. SPRINGERPLUS 2016; 5:1716. [PMID: 27777852 PMCID: PMC5052246 DOI: 10.1186/s40064-016-3348-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/21/2016] [Indexed: 12/25/2022]
Abstract
Currently, whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is superior to conventional TBNA (cTBNA) in the diagnosis of mediastinal lymphadenopathy remains controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) to evaluate the diagnostic yield of EBUS-TBNA versus cTBNA in the diagnosis of mediastinal lymphadenopathy, both in benign and malignant etiologies. Computer-based retrieval was performed on PubMed and EMBASE. The quality was evaluated according to the quality assessment of diagnostic accuracy studies-2, and Meta-Disc was adopted to perform meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95 % confidence intervals (CIs) were calculated. The summary receiving operating characteristic curve as well as the areas under curve (AUC) was measured. Four studies with a total of 440 patients met the inclusion criteria. Our results showed that the pooled sensitivity was 0.90 (95 % CI 0.85-0.94) and 0.76 (95 % CI 0.68-0.82), pooled specificity was 0.75 (95 % CI 0.60-0.87) and 0.94 (95 % CI 0.86-0.98), DOR was 75.38 (95 % CI 16.38-346.97) and 108.17 (95 % CI 13.84-845.35), and AUC was 0.9339 and 0.9732 for EBUS-TBNA group and cTBNA group, respectively. Although EBUS-TBNA with a higher sensitivity performs better than cTBNA, there is lack of enough evidence regarding EBUS-TBNA being superior to cTBNA in the diagnosis of mediastinal lymphadenopathy. Considering the limitations of methodology and limited data, further robust RCTs are needed to verify the current findings and investigate the optimal choice in patients receiving TBNA.
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Affiliation(s)
- Jun-Hong Yan
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou, 256603 China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, 256603 China
| | - Xiao-Li Chen
- Department of Critical Care Medicine, Jining First People's Hospital, Jining, 272001 China
| | - Jian-Wei Chen
- Department of Infection Management, Binzhou Medical University Hospital, Binzhou, 256603 China
| | - Li-Ming Yan
- Department of Infection Management, Binzhou Medical University Hospital, Binzhou, 256603 China
| | - Bao Liu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, 450003 China
| | - Yong-Zhong Guo
- Department of Respiratory Medicine, Xuzhou Central Hospital, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, 199 South Jiefang Road, Xuzhou, 221009 Jiangsu China
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Poletti V, Ravaglia C, Gurioli C, Piciucchi S, Dubini A, Cavazza A, Chilosi M, Rossi A, Tomassetti S. Invasive diagnostic techniques in idiopathic interstitial pneumonias. Respirology 2016; 21:44-50. [PMID: 26682637 DOI: 10.1111/resp.12694] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022]
Abstract
Fibrosing interstitial lung diseases (f-ILDs) represent a heterogeneous group of disorders in which the aetiology may be identified or, not infrequently, remain unknown. Establishing a correct diagnosis of a distinct f-ILD requires a multidisciplinary approach, integrating clinical profile, physiological and laboratory data, radiological appearance and, when appropriate, histological findings. Surgical lung biopsy is still considered the most important diagnostic tool as it is able to provide lung samples large enough for identification of complex patterns such as usual interstitial pneumonitis (UIP) and nonspecific interstitial pneumonitis. However, this procedure is accompanied by significant morbidity and mortality. Bronchoalveolar lavage is still a popular diagnostic tool allowing identification of alternative diagnoses in patients with suspected idiopathic pulmonary fibrosis (IPF) when an increase in lymphocytes is detected. Conventional transbronchial lung biopsy has a very low sensitivity in detecting the UIP pattern and its role in this clinical-radiological context is marginal. The introduction of less invasive methods such as transbronchial cryobiopsy show great promise to clinical practice as they can be used to obtain samples large enough to morphologically support a diagnosis of IPF or other idiopathic interstitial pneumonias, along with fewer complications. Recent advances in the field suggest that less invasive methods of lung sampling, without significant side effects, in combination with other diagnostic methods could replace the need for surgical lung biopsy in the future. Indeed, these new multidisciplinary procedures may become the main diagnostic work-up method for patients with suspected idiopathic interstitial pneumonia.
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Affiliation(s)
- Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Carlo Gurioli
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Departments of Radiology, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | | | - Alberto Cavazza
- Operative Unit of Pathology, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Marco Chilosi
- Department of Pathology, Verona University, Verona, Italy
| | - Andrea Rossi
- Pulmonary Unit, University of Verona, Verona, Italy
| | - Sara Tomassetti
- Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
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Carmona EM, Kalra S, Ryu JH. Pulmonary Sarcoidosis: Diagnosis and Treatment. Mayo Clin Proc 2016; 91:946-54. [PMID: 27378039 DOI: 10.1016/j.mayocp.2016.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
Abstract
Sarcoidosis is a chronic granulomatous disease of unknown cause that is seen worldwide and occurs mainly in patients between the ages of 20 and 60 years. It can be difficult to diagnose because it can mimic many other diseases including lymphoproliferative disorders and granulomatous infections and because there is no specific test for diagnosis, which depends on correlation of clinicoradiologic and histopathologic features. This review will focus on recent discoveries regarding the pathogenesis of sarcoidosis, common clinical presentations, diagnostic evaluation, and indications for treatment. This review is aimed largely at general practitioners and emphasizes the importance of differentiating pulmonary sarcoidosis from its common imitators.
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Affiliation(s)
- Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Sanjay Kalra
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Michaud GC, Channick CL, Law AC, McCannon JB, Antkowiak M, Garrison G, Sayah D, Huynh RH, Brady AK, Adamson R, DuBrock H, Akuthota P, Marion C, Dela Cruz C, Town JA, Çoruh B, Thomson CC. ATS Core Curriculum 2016. Part IV. Adult Pulmonary Medicine Core Curriculum. Ann Am Thorac Soc 2016; 13:1160-9. [PMID: 27388404 PMCID: PMC6138058 DOI: 10.1513/annalsats.201601-060cme] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gaëtane C Michaud
- 1 Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | - Colleen L Channick
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anica C Law
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica B McCannon
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - MaryEllen Antkowiak
- 3 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Garth Garrison
- 3 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - David Sayah
- 4 Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California
| | - Richard H Huynh
- 4 Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California
| | - Anna K Brady
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Rosemary Adamson
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Hilary DuBrock
- 6 Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Praveen Akuthota
- 6 Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Chad Marion
- 7 Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Charles Dela Cruz
- 7 Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - James A Town
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Başak Çoruh
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Carey C Thomson
- 8 Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
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James WE. Leaving History Behind: CD4/CD8 Ratio as a Diagnostic Tool in Sarcoidosis. EBioMedicine 2016; 8:20. [PMID: 27428410 PMCID: PMC4919717 DOI: 10.1016/j.ebiom.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- W Ennis James
- Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, SC, United States.
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Zhou Y, Lower EE, Li H, Baughman RP. Clinical management of pulmonary sarcoidosis. Expert Rev Respir Med 2016; 10:577-91. [DOI: 10.1586/17476348.2016.1164602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lee P, Leung CC, Restrepo MI, Takahashi K, Song Y, Porcel JM. Year in review 2015: Lung cancer, pleural diseases, respiratory infections, bronchiectasis and tuberculosis, bronchoscopic intervention and imaging. Respirology 2016; 21:961-7. [PMID: 26998678 DOI: 10.1111/resp.12779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Chi Chiu Leung
- Department of Health, TB and Chest Service, Hong Kong, China
| | - Marcos I Restrepo
- South Texas Veterans Health Care System ALMD, San Antonio, Texas, USA
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - José M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, Lleida, Spain
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Mishra MM, Reynolds JP, Sturgis CD, Booth CN. Diagnosis of mediastinal lesions unassociated with lung carcinoma diagnosed by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). J Am Soc Cytopathol 2016; 5:189-195. [PMID: 31042508 DOI: 10.1016/j.jasc.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe, cost-effective, and accurate diagnostic modality for the lung/mediastinum. Although some studies have been published on EBUS-TBNA of isolated mediastinal lesions, none have been reported from the United States. This study examines EBUS-TBNA for diagnosis of isolated mediastinal lesions. MATERIALS AND METHODS All cases of mediastinal EBUS-TBNA (defined in radioanatomic terms) during a 7-year period (July 2007-September 2014) were obtained from the anatomic pathology database. Pathologic reports, clinical notes, bronchoscopy notes, and imaging studies were reviewed. Only patients with a mediastinal lesion or non-pulmonary parenchyma-based lesions sampled by EBUS-TBNA without a prior or synchronous lung carcinoma were included in this study. RESULTS Of the 3005 EBUS-TBNA cases accessioned during this time period at our institute, 47 fulfilled the inclusion criteria. The median patient age was 61 years (range: 27-84 years). Both genders were nearly equally represented. A definitive cytologic interpretation was rendered in 40 out of 47 cases (85.1%). Malignancies included non-pulmonary carcinomas (8), sarcomas (5), hematolymphoid malignancies (5), neuroendocrine neoplasm (1), melanoma (1), and undifferentiated malignancy (1). Surgical follow-up was available in 18 of 47 cases (38.3%). There was cytologic-histologic correlation in 16 of 18 cases (88.9%). Surgical follow-up of all cysts diagnosed by cytology were benign cysts. Over the 7-year period, an increasing proportion of all EBUS-TBNAs performed were for mediastinal lesions unassociated with lung carcinoma. CONCLUSIONS EBUS-TBNA has a high accuracy rate when used to diagnose mediastinal lesions unassociated with lung carcinoma. Its utility as a primary diagnostic modality in this setting needs to be explored further.
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Affiliation(s)
- Manisha M Mishra
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Osinka K, Zielińska-Krawczyk M, Korczyński P, Górnicka B, Krenke R. Impact of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration on Diagnostic Yield of Bronchoscopy in Patients with Mediastinal Lymph Node Enlargement. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 911:33-43. [PMID: 26987324 DOI: 10.1007/5584_2016_222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) had an enormous impact on the current advancement in diagnostic bronchoscopy. The aims of the present study were: (1) to evaluate the added value of EBUS-TBNA to routine diagnostic bronchoscopy performed in patients with mediastinal lymph node enlargement and (2) to identify factors that affect the diagnostic yield of EBUS-TBNA. We retrospectively analyzed 712 EBUS-TBNA procedures out of the 4081 bronchoscopies performed in the years 2009-2014. The number of EBUS-TBNA procedures increased from 61 (8.8 % of all bronchoscopies) in 2009 to 160 (21.4 %) in 2014. In 625 (87.8 %) patients adequate cytological material was obtained. Based on cytological examination of EBUS-TBNA aspirates, specific diagnosis was made in 367 (51.5 %) patients. The forceps biopsy of endobronchial lesions provided specific diagnosis in only 204 (28.6 %) patients. The percentage of patients with EBUS-TBNA based diagnosis increased steadily from 34.4 % in 2009 to 65.0 % in 2014 (p < 0.0001). The median lymph node diameter in patients with positive EBUS-TBNA findings was 20 (IQR 15-30) mm and was significantly larger than that in patients with negative EBUS-TBNA results (15 (IQR 10-20) mm, p = 0.0001). The highest diagnostic yield (78.5 %) was found in patients with lymph node dimension between 31 mm and 40 mm. We conclude that EBUS-TBNA is a valuable diagnostic method in an unselected group of patients with mediastinal lymph node enlargement. The percentage of positive EBUS-TBNA diagnoses is related to lymph node dimensions. The overall efficacy of EBUS-TBNA improves with increasing years of experience.
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Affiliation(s)
- K Osinka
- Medical Student Research Group 'Alveolous', Medical University of Warsaw, Warsaw, Poland
| | - M Zielińska-Krawczyk
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland
| | - P Korczyński
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland.
| | - B Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - R Krenke
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW The usual diagnostic criteria for sarcoidosis include the documentation of a compatible clinicoradiologic scenario, biopsy proof of granulomas, and exclusion of alternate causes for the findings. Establishing the presence of multisystem disease, and longitudinal assessment for the emergence of potential sarcoidosis mimics both strengthen the diagnosis. These principles have constituted a 'diagnostic modus operandi' for several decades, but the emergence of several new technologies has begun to transform their application. RECENT FINDINGS The widespread availability of high-resolution chest computed tomography, endobronchial ultrasound-guided transbronchial needle aspiration, rapid on-site cytopathology and to a lesser degree, fluorodeoxyglucose positron emission tomography have facilitated more convenient diagnosis. They also have identified possibilities for biopsy-less diagnosis in appropriate clinical contexts, similar to idiopathic pulmonary fibrosis, and allowed for more comprehensive assessment of the extent and activity of disease. Nonetheless, these new technologies cannot replace the central role of the clinician, whose judgment and circumspection are keys to accurate diagnosis. SUMMARY The diagnosis of sarcoidosis and the assessment of its extent should be tailored to the clinical situation. The application of new technologies may permit some evolution of the diagnostic approach in many patients.
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Affiliation(s)
- Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland, Ohio, USA
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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Frye BC, Schupp JC, Köhler TL, Müller-Quernheim J. [Diagnosis and treatment of sarcoidosis. Current standards]. Internist (Berl) 2015; 56:1346-52. [PMID: 26563335 DOI: 10.1007/s00108-015-3757-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sarcoidosis is a granulomatous disease that mainly affects the lungs and intrathoracic lymph nodes; however, virtually any organ can be affected. As an orphan disease, recommendations are mainly based on observational or small randomized studies as well as experts' opinion. Diagnosing sarcoidosis requires proof of non-necrotizing granulomas in patients with a compatible symptomatic pattern and the exclusion of other granulomatous diseases. Granulomas can be detected best in the lungs or intrathoracic lymph nodes. Therefore, bronchoscopy and endobronchial ultrasound with biopsies of lymph nodes are the major tools to diagnose sarcoidosis. Frequently, close follow-up and symptomatic therapy are sufficient to allow for spontaneous resolution. In case of functional organ impairment, cardial or CNS involvement, or other complications, steroid therapy is necessary with a starting dose of 0.5 mg/kg body weight that should be tapered-off over 6-12 months. Steroid-refractory disease can be treated by adding methotrexate or azathioprine, two drugs long known in sarcoidosis treatment. Monoclonal antibodies against TNF and lung transplantation are further therapeutic options.
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Affiliation(s)
- B C Frye
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - J C Schupp
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T L Köhler
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Fernández-Villar A, Mouronte-Roibás C, Botana-Rial M, Ruano-Raviña A. Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness. Arch Bronconeumol 2015; 52:96-102. [PMID: 26565072 DOI: 10.1016/j.arbres.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022]
Abstract
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.
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Affiliation(s)
- Alberto Fernández-Villar
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España.
| | - Cecilia Mouronte-Roibás
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Maribel Botana-Rial
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España; CIBER de Epidemiología y Salud Pública, CIBERESP, España
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