Comparison Of The Diagnostic Value Of Different Biopsy Under Electronic Bronchoscope For Pulmonary Sarcoidosis

Background:Sarcoidosis is an unexplained multi-system disease characterized by the formation of non-caseous necrotizing epithelial cell granuloma.Often presents with bilateral hilar lymphadenopathy,lung infiltration,eye and skin damage.The clinical course of sarcoidosis is diverse.More than 90% of sarcoidosis has lung involvement.Histopathologic diagnosis of tissue biopsy is the basis for the diagnosis of sarcoidosis.For patients suspected of sarcoidosis who consider hormone therapy,other causes of granuloma are excluded,such as tuberculosis,fungus etc,to obtain pathological diagnosis is very necessary.Surgical lung biopsy and mediastinoscopic collection of mediastinal/hilar lymph node specimens are the gold standard for diagnosis.However,transbronchial lung biopsy(TBLB),endobronchial biopsy(EBB),transbrochialneedle aspiration(TBNA),and endobronchialultrasound-guided transbronchial needle aspiration(EBUS-TBNA)has reduced the majority Patient needs for invasive surgical biopsy.In this study,retrospective analysis of 65 patients with suspected sarcoidosis of clinical and thoracic imaging underwent bronchoscopy was performed to investigate the effect of different bronchoscopic sampling and combination methods on the diagnosis of pulmonary sarcoidosis,so that clinicians could Choose the most effective and valuable diagnostic method among the means.Objective:Discuss the diagnostic value of traditional bronchoscopy(TBLB,EBB,and TBNA),EBUS-TBNA acquisition,and combined acquisition methods for pulmonary sarcoidosis,and promote the standardization of bronchoscopic techniques for the diagnosis of sarcoidosis.Methods:From January 2011 to December 2017,65 cases of clinical and thoracic imaging in the Department of Respiratory Medicine of the Second Hospital of Kyrgyzstan showed mediastinal or hilar lymphadenopathy with or without pulmonary infiltrating shadows suspected of sarcoidosis.Patients with bronchoscopy were enrolled in the study and patients with malignant or previously confirmed sarcoidosis were excluded.(1)Retrospective analysis of patients' age,gender,clinical manifestations,imaging staging,and histopathological methods;(2)Comparison of the positive rates of different pathological and combined methods.Result:Sixty-five patients with suspected sarcoidosis underwent bronchoscopy.46 cases of non-caseous necrotizing granulomas were confirmed by biopsy.The total positive rate was 70.8%.According to the chest X-ray and/or CT appearance of the patients,staging was performed in 13 cases(28.2%)in stage I,29 cases(63.0%)in stage II,4 cases(8.7%)in stage III,and 0 cases in stage IV.The positive rate in stage I was 78.6%,the positive rate in stage II was 67.6%,and the positive rate in stage III was 71.4%.The positive rates of EBB,TBLB,TBNA,and EBUS-TBNA were 35.7%,70.6%,86.7%,and 100%,respectively.In patients with EBB alone,the positive rate of small nodular changes(55.6%)was higher than that of mucosal hyperemia(43.8%).There was no significant difference between the two groups(P > 0.05).The positive rates of TBLB on stage II and III were higher,70% and 80% respectively,and the positive rate on stage I was 50%.The positive rate of EBB and TBLB was 87.5%,which was significantly different from EBB alone(P<0.05).The positive rate of TBNA was higher in stage I/II alone.The positive rate of TBNA combined with TBLB was not significantly increased compared with TBNA alone,and the difference was not statistically significant(P > 0.05).In this study,only one patient with suspected sarcoidosis underwent EBUS-TBNA and eventually proved to be sarcoidosis.Of the negative patients who underwent bronchoscopy,one patient underwent mediastinoscopy and one patient underwent percutaneous lung puncture to confirm sarcoidosis.Of the 17 patients misdiagnosed,11 were tuberculosis,4 lung cancer,1 lymphadenopathy,and 1 cryptococcosis pneumonia.Hemoptysis occurred in 3 cases after operation,1 case was found in EBB,2 cases were seen in TBLB,flushed with iced saline,and then hemostasia stopped.A small amount of pneumothorax occurred after TBLB in 2 cases.There is no program-related mortality.Conclusion:1.For cases with typical bronchial mucosal changes under microscope,EBB examination is safe,simple,and has a high diagnostic rate.It should be used as the first choice.Combined with TBLB,the positive rate can be improved,but there is no further requirement for TBNA;no typical mucosa is found under the microscope.In patients who have changed,TBLB has some additional diagnostic value.2.TBLB not only has high diagnostic value for patients with stage II and III,but also can obtain positive results for stage I cases.The TLBB alone has a higher diagnostic positive rate for patients with stage II and III pulmonary sarcoidosis.Combined with EBB and TBNA can significantly increase the diagnostic positive rate of EBB and TBNA,but at the same time,the operation time and the incidence of complications increase.3.For suspected I/II sarcoidosis,TBNA may be preferentially selected and combined with TBLB to improve the diagnosis rate of pulmonary sarcoidosis.