How to achieve the higher diagnostic yield using EBUS-TBNA method to confirm sarcoidosis?

INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic tool to obtain cytological specimens from enlarged mediastinal lymph nodes and is recommended to use in diagnosis of sarcoidosis.However the mean of diagnostic yield is between 70-80%. AIMS AND OBJECTIVES: To determine the potential benefit from puncturing more than one station of mediastinal lymph nodes, and how adding endobronchial biopsy (EBB) increase diagnostic yield. METHODS: Fifty two patients with suspicion of sarcoidosis (stage I,II) were included in this prospective study. Patients underwent diagnostic conventional bronchoscopy with EBB followed by EBUS-TBNA. In 19 patients one station of lymph nodes was biopsied. In 33 cases more than one (two or three) stations (7, and 4R/4L and/or 10R/10L and/or 11R/11L) were punctured. RESULTS: The presence of noncaseating granulomas that corresponded to clinical and radiological picture of sarcoidosis was obtained in 49 patients (94.23%).One patient was confirmed by VTS, one by skin biopsy and one had reactive lymph nodes. The overall diagnostic accuracy for EBUS-TBNA was 86.53%. Endobronchial biopsy was positive in 12 patients (23.07%)and increased verification to 94.23%. Sensitivity of EBUS-TBNA with EBB was 96,1%, specificity 100%, PPV 100% and NPV 33,3%. Granulomas from one lymph nodes group were obtained in 73.68%. In group of two or three stations punctured cytology was positive in 93.93% (p=0.039) CONCLUSIONS: The diagnostic yield of the EBUS/TBNA performed from more than one lymph node stations was significantly higher. Addition EBB to EBUS-TBNA in sarcoidosis verification may also increase the diagnostic yield.