Diagnostic Value Of Trans-bronchial Needle Aspiration In Pulmonary Sarcoidosis Ⅰ And Ⅱ

Objective:To investigate value of Trans-bronchial Needle Aspiration (TBNA) and combination with Transbronchial lung biopsy(TBLB) in the diagnosis of pulmonary sarcoidosis I and II.Methods:Forty-egiht patients suspected of having pulmonary sarcoidosis were retrospectively investigated in department of respiratory in Shandong Provincial Hospital from April2008to December2011. including28males and20females, average age48.3years old(ranged18-67years). The patients need to meet the conditions:(1) The chest radiograph consistent with pulmonary sarcoidosis stage I or II were entered into the study;(2) All patients had a chest radiograph and contrast-enhanced chest computed tomography before TBNA;(3) The routine blood test, conventional coagulation test, five items of hepatitis B, and cardiogram should be normal before bronchoscopy and each patient signed a consent form. Approach:(1) Aerosol inhalation of2%lidocaine for20min before bronchoscopy, and asked the patient lying on checking bed. Inhaled oxygen for convention, observed with continuous monitoring of oxygen saturation and heart rate during the procedure;(2) According to CT and bronchoscopy appearance, selected the nodes, the puncture position and the puncture angle. A minimum of three passes per nodes were punctured, then acid-fast bacillus, fungal, and cytology were detected immediately. The diagnosis of pulmonary sarcoidosis need to meet the condition:(1) Patients were eligible for the study according to clinical manifestation of pulmonary sarcoidosis, and had hilar and (or) mediastinal adenopathy confirmed on CT scan of chest;(2) Non-caseating epithelial cell granmlomas was indentified by histological or cytological, without acid-fast bacillus, fungal;(3) Other granulomatous diseases were excluded. Mediastinoscopy was performed in those in whom non-caseating epithelial cell granmlomas were not detected by TBNA and TBLB.Results:In forty-eight patients suspected pulmonary sarcoidosis, the positive rate of TBNA is28/48(58.3%), the positive rate of TBLB is22/48(45.8%), and the positive rate of TBNA combined with TBLB is40/48(83.3%). Further analysis the result, the positive rate of TBNA in suspected pulmonary sarcoidosis I is18/30(60%), and the positive rate of TBNA in suspected pulmonary sarcoidosis II is10/18(55.6%); The positive rate of TBNA combined with TBLB in suspected pulmonary sarcoidosis I is26/30(86.7%), the positive rate of TBNA combined with TBLB in suspected pulmonary sarcoidosis II is14/18(77.8%). No complications were detected in this study, including pneumothorax, pneumomediastinum or excessive bleeding. Mediastinoscopy was performed in eight patients in whom non-caseating epithelial cell granmlomas were not detected by TBNA and TBLB. Finally, five patients were diagnosed as sarcoidosis, one patient was diagnosed as Wegener’s granulmonatosis, one patient was diagnosed as small lung cancer (SCLC), and one patient was not indefinite.Conclusion:TBNA proved to be a safe procedure with a high positive rate in diagnosis of pulmonary sarcoidosis, and the positive rate increased significantly when combined with TBLB, especially in pulmonary sarcoidosis I. Mediastinoscopy was necessary when non-caseating epithelial cell granmlomas were not detected by TBNA and TBLB.