Endobronchial ultrasound diagnostic yield for sarcoidosis in hilar vs. mediastinal lymph nodes.

BACKGROUND: Pulmonary sarcoidosis is diagnosed by endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA) of hilar and mediastinal lymph nodes and the finding of non-caseating granulomatous inflammation. There are currently no guidelines about which lymph node stations to sample to optimize the diagnostic yield and it is unclear if there is a difference in the yield between hilar and mediastinal lymph node stations. The objective of this study was to assess the difference in the diagnostic yield of EBUS-TBNA for non-caseating granulomas between hilar and mediastinal lymph nodes. METHODS: A retrospective study was performed and medical records were reviewed of all patients at a single institution who underwent EBUS-TBNA of thoracic lymph nodes to evaluate for sarcoidosis. RESULTS: Two hundred twenty-five patients with suspicion of sarcoidosis underwent EBUS-TBNA for evaluation of hilar and mediastinal lymphadenopathy. The yield of EBUS-TBNA for non-caseating granulomas was 61.8% vs. 65.5%, P=0.46, for hilar and mediastinal lymph nodes, respectively. The sensitivity for sarcoidosis of EBUS-TBNA of hilar vs. mediastinal nodes was 66.9% [95% confidence interval (CI): 58.9-74.9%] vs. 71.1% (95% CI: 65.3-76.9%). The specificity for sarcoidosis of EBUS-TBNA of both hilar and mediastinal nodes was 100%. The diagnostic yield for non-caseating granulomas in patients who underwent hilar nodes biopsy only, mediastinal nodes biopsy only, and both hilar and mediastinal nodes biopsy was 71.4%, 67%, and 73.1%, respectively (P=0.63). In multivariable logistic regression analysis, the diagnostic yield of EBUS-TBNA was only associated with age [odds ratio (OR) 0.96; 95% CI: 0.94-0.98; P<0.01]. CONCLUSIONS: The yield of EBUS-TBNA for non-caseating granulomas in patients with suspected sarcoidosis was similar between the hilar and mediastinal lymph nodes.

Duke Scholars

Author Kamran Mahmood Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Scott Leigh Shofer Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Momen Mohammed Wahidi Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Rajesh Chandra Dash Pathology

Author Xiaofei Wang Biostatistics & Bioinformatics, Division of Biostatistics

Author Coral Xantia Giovacchini Medicine, Pulmonary, Allergy, and Critical Care Medicine