Combination of endoscopic techniques - number of lymph nodes stations biopsies and application of cell blocks in the sarcoidosis diagnosis

Introduction: Diagnosis of sarcoidosis is usually made on the basis of clinical outcome and imaging techniques but its configuration requires detection of noncaseating granulomas in biopsy specimen. The role of bronchoscopic sampling techniques in diagnosis of sarcoidosis is still discussed. Aims and Objectives: To determine the potential benefit of EBUS-TBNA and EBB (endobronchial biopsy) combination, application of cell blocks and puncturing more than one station of lymph nodes in diagnosis of sarcoidosis. Methods: Fifty two patients mean age 46.4±12.9 with suspicion of sarcoidosis (stage I, II) were included in this prospective study. Patients underwent diagnostic conventional bronchoscopy with EBB followed by EBUS-TBNA. One (group 7) or two (group 7, and 4R/4L or 10R/10L or 11R/11L) lymph nodes stations were punctured. Smear and cell blocks were performed and examined. Results: EBB was positive in 16 patients (30.8%). EBUS-TBNA was diagnostic in 86.5%. Combination of EBUS-TBNA and EBB increased diagnostic yield of sarcoidosis (86.5% vs 98.1%; p=0.02). Sensitivity of EBUS-TBNA with EBB was 100%, specificity 98.1%, PPV 100% and NPV 100%. Granulomas from one lymph nodes group were obtained in 78.8%, in group of two stations punctured cytology was positive in 86.5% (p=0.2). Application of cell blocks did not increase diagnostic yield of EBUS-TBNA in sarcoidosis. Conclusions: Combining of EBUS-TBNA of at least two lymph nodes stations and EBB increase diagnostic yield of sarcoidosis. Cell block specimens have not further impact on the diagnostic yield of the procedure.