Clinical Utility of Transbronchial Needle Aspiration of Mediastinal Lymph Nodes in the Diagnosis of Sarcoidosis in Stages I and II

Fernández-Villar, Alberto; Botana, María Isabel; Leiro, Virginia; Represas, Cristina; González, Ana; Mosteiro, Mar; Piñeiro, Luis

doi:10.1016/S1579-2129(07)60114-1

Archivos de Bronconeumología

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Vol. 43. Issue 9.

Pages 495-500 (January 2007)

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Pages 495-500 (January 2007)

Original Articles

DOI: 10.1016/S1579-2129(07)60114-1

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Clinical Utility of Transbronchial Needle Aspiration of Mediastinal Lymph Nodes in the Diagnosis of Sarcoidosis in Stages I and II

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Alberto Fernández-Villara,

Corresponding author

Alberto.Fernandez.Villar@sergas.es

Correspondence: Dr. A. Fernández-Villar. Unidad de Broncoscopias. Servicio de Neumología. Hospital Xeral de Vigo. Pizarro, 22. 36204 Vigo. Pontevedra. España

, María Isabel Botanaa, Virginia Leiroa, Cristina Represasa, Ana Gonzálezb, Mar Mosteiroa, Luis Piñeiroa

a Servicio de Neumología, Hospital Xeral de Vigo, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain

b Servicio de Anatomía Patológica, Hospital Xeral de Vigo, Complexo Hospitalario Universitario de Vigo, Pontevedra, Spain

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Objective

To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II.

Patients and methods

We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies.

Results

A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well.

Conclusions

Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good.

Key words:

Sarcoidosis

Bronchoscopy

Transbronchial needle aspiration

Transbronchial biopsy

Bronchoalveolar lavage

Objetivo

Analizar tanto la rentabilidad individual como La conjunta y la utilidad clínica de la punción transbronquial (PTB) y la biopsia transbronquial (BTB) en el diagnóstico histológico de sarcoidosis en estadios I y II.

Pacientes y métodos

Se ha realizado un estudio pros-pectivo en el que se incluyó a todos los pacientes con adenopatías mediastínicas de diámetro superior a 10 mm y sospecha clinicorradiológica de sarcoidosis, ingresados entre julio de 2001 y junio de 2006. Se realizó a todos, por este orden, PTB con agujas Bard-Wang 319 de una o más adenopatías hasta obtener un mínimo de 2 muestras satisfactorias; lava-do broncoalveolar, y 4-6 BTB.

Resultados

Se incluyó en el estudio a 32 pacientes, de los que 26 presentaron un diagnóstico final de sarcoidosis. La edad media ± desviación estándar fue de 38,9 ± 10,6 años y 13 (50%) eran mujeres. El diámetro medio de las adenopatías fue de 23,5 ± 6,5 mm. Las estaciones ganglionares más puncionadas fueron la subcarinal, con 9 casos (37,7%), y la combinación subcarinal-paratraqueal derecha, con 7 (26,9%). Se observó afectación parenquimatosa en la tomografía computarizada de tórax en 12 (46,2%). La BTB fue diagnóstica en 15 pacientes (57,7%) y la PTB en 16 (61,5%), y fueron las únicas técnicas diagnósticas en 7 (26,9%) y 8 (30,8%) casos, respectivamente (p > 0,05). La combinación de ambas fue diagnóstica en 23 casos (88,4%), significativamente superior a la BTB (p = 0,01) y a la PTB (p = 0,02) por separado en todos los casos, y sólo a la BTB (p = 0,01) en los casos con afectación parenquimatosa. Únicamente 4 pacientes (15%) presentaron alguna complicación y en 20 (76,9%) la tolerancia fue buena.

Conclusiones

La adición de la PTB a la BTB incrementa significativamente el número de diagnósticos de sarcoidosis, sobre todo en pacientes sin afectación parenquimatosa. El número de complicaciones es bajo y la tolerancia, buena.

Palabras clave:

Sarcoidosis

Broncoscopia

Punción transbronquial

Biopsia transbronquial

Lavado broncoalveolar

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