Application And Comparison Of EBUS-TBNA And Conventional TBNA In Diagnosis Of Sarcoidosis

Background:Sarcoidosis is a multisystem disorder of uncertain etiology,characterized by non-caseating granuloma formation in the affected organs.The usual diagnostic criteria for sarcoidosis include the documentation of a compatible clinic radiologic scenario,biopsy proof of granulomas,and exclusion of alternate causes for the findings,such as tuberculosis,lymphoma,malignancy with a sarcoid-like reaction and histoplasmosis.Therefore,histological confirmation is of great importance.Both endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)and conventional transbronchial needle aspiration(cTBNA)are valuable diagnostic methods for sarcoidosis,and transbronchial lung biopsy(TBLB)is still often used for making a pathologic diagnosis of sarcoidosis.The aim of the study was to compare the diagnostic yield of EBUS-TBNA with cTBNA,TBLB,cTBNA plus TBLB in stages?(hilar lymphadenopathy)and ?(hilar lymphadenopathy and parenchymal involvement)of pulmonary sarcoidosis.Methods:A total of 142 patients with suspected stage ? and ? sarcoidosis from January 2013 to January 2017 were included in this retrospective study,EBUS group contained 59 patients.cTBNA group contained 83 patients,63 patients underwent cTBNA among them,and the remaining 20 patients underwent cTBNA plus TBLB.The primary endpoint was to compare the diagnostic yield of EBUS-TBNA and cTBNA,TBLB,cTBNA plus TBLB.The secondary end points were to compare the diagnostic yield of different lymph node station and stage between EBUS-TBNA and cTBNA,the number of sampled lymph nodes per patient between EBUS-TBNA and cTBNA,and the serious adverse events.Results:In 142 patients,sarcoidosis was diagnosed in 125(51EBUS-TBNA,56c TBNA,18cTBNA+TBLB).Non-caseating granulomas were detected in 92 patients(43 patients through EBUS-TBNA,36 patients through cTBNA,13 patients throu gh cTBNA+TBLB).Diagnostic yield for EBUS-TBNA reached 84.3%(43/51),whi ch was significantly higher than cTBNA(64.3%36/56,p<0.05)and TBLB(38.9%7/18,p<0.05),but not cTBNA combined TBLB(72.2%13/18,p>0.05).The diagn ostic yield of stations 4 sampled by EBUS-TBNA was 82.6%,which was not significantly higher than cTBNA(60.6%,p>0.05).The diagnostic yield of stati on 7 sampled by EBUS-TBNA vs cTBNA was 81.4%vs 66.7%,which was not significant statistically(P>0.05).However,the diagnostic yield of other lymph node stations(10R,10L,11R,11L,12R,12L)at EBUS-TBNA was significan tly higher than cTBNA(82.5%vs 64.7%,p<0.05).The overall number of sample d lymph node for EBUS-TBNA was 123,for cTBNA was 178,but the mean(±SD)number of sampled lymph node per patient for EBUS-TBNA was signifi cantly fewer than that for cTBNA(2.08±0.79 vs 2.83±1.10,p<0.05).The yield by radiographic stage I of EBUS-TBNA vs cTBNA was 91.3%vs 78.6%,which has no significantly difference(p=0.063).The yield by radiographic stage II of EBUS-TBNA(69.6%)was not significantly higher than cTBNA(60.6%,p=0.13).In 142 patients,1 patient had mild hemorrhage through EBUS-TBNA,4 patients had mild hemorrhage through cTBNA,1 patient had hemoptysis aft er cTBNA,2 patients had mild hemorrhage through cTBNA+TBLB.1 patient had chest distress after cTBNA combined TBLB,which was relieved with supp lemental oxygen.All patients recovered completely.There were no serious adve rse events occurred.Conclusion:The diagnostic rate by EBUS-TBNA was significantly higher than cTBNA and TBLB.However,there was no significant difference between EB US-TBNA and cTBNA plus TBLB in sarcoidosis.Therefore,EBUS-TBNA can be used as the preferred diagnostic method which additional procedures were rarely required in sarcoidosis and the number of sampled lymph node was few er.However,when EBUS-TBNA is unavailable,cTBNA plus TBLB may beco me an alternative diagnostic method for sarcoidosis.