Background

Diagnosis of extra-pulmonary sarcoidosis can be difficult, and a biopsy is usually required. We evaluated the utility of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in patients with suspected extra-pulmonary sarcoidosis with thoracic lymph nodes ≤10 mm on chest computed tomography (CT) and no or minimal pulmonary infiltrates.

Methods

The Cleveland Clinic bronchoscopy registry was screened. Patients with thoracic lymph nodes >10 mm on short axis or significant pulmonary infiltrates in the chest CT scan were excluded. Two separate analyses using expert consensus (before and after release of bronchoscopy results) were the reference standard.

Results

15 patients met the inclusion criteria. 40% had suspected ocular, 33% cardiac and 27% neurologic sarcoidosis. Six patients (40%) had EBUS-TBNA compatible with sarcoidosis. When the reference standard was the consensus diagnosis blinded to bronchoscopy results, the sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were 56%, 83%, 83%, and 56% respectively. The combination of a positive EBUS-TBNA and BAL CD4/CD8 improved the specificity from 83 to 100%, but the difference was not statistically significant (p = 0.074). When the reference standard was the consensus diagnosis with the bronchoscopic results, the sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were 75%, 100%, 100%, and 78% respectively.

Conclusions

In patients with suspected extra-pulmonary sarcoidosis, the EBUS-TBNA may be useful in the diagnosis of patients with thoracic lymph nodes ≤10 mm and no or minimal pulmonary infiltrates on chest CT. Larger and prospective studies are needed to validate our findings.

中文翻译：

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支气管内超声-经支气管针吸术在疑似无胸腔淋巴结肿大的肺外结节病患者中的应用。

背景

诊断肺外结节病可能很困难，通常需要进行活检。我们评估了胸腔计算机断层扫描（CT）对怀疑肺外结节病且胸腔淋巴结≤10mm且无或仅有少量肺浸润的支气管内超声-经支气管针吸术（EBUS-TBNA）的实用性。

方法

筛选了克利夫兰诊所的支气管镜注册系统。排除短轴胸淋巴结> 10 mm或胸部CT扫描发现明显肺浸润的患者。使用专家共识（在发布支气管镜检查结果之前和之后）进行的两次单独分析是参考标准。

结果

15名患者符合纳入标准。40％怀疑患有眼病，33％患有心脏疾病和27％患有神经系统结节病。六名患者（40％）患有与结节病相容的EBUS-TBNA。当参考标准是对支气管镜检查结果不了解的共识诊断时，EBUS-TBNA的敏感性，特异性，阳性预测值和阴性预测值分别为56％，83％，83％和56％。阳性EBUS-TBNA和BAL CD4 / CD8的结合可使特异性从83％提高到100％，但差异无统计学意义（p = 0.074）。当参考标准与支气管镜检查结果一致诊断时，EBUS-TBNA的敏感性，特异性，阳性预测值和阴性预测值分别为75％，100％，100％和78％。

结论

对于疑似肺外结节病的患者，EBUS-TBNA可能有助于诊断胸部淋巴结≤10 mm且胸部CT上无或仅有少量肺浸润的患者。需要更大规模和前瞻性的研究来验证我们的发现。