The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis

¹ Dept. Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
² Dept. Respiratory Medicine, Clinique Sainte Elisabeth, Namur, Belgium
³ Dept. Respiratory Medicine, Amphia Ziekenhuis, Breda, the Netherlands
⁴ Dept. Respiratory Medicine, CH Universitaire, Charleroi, Belgium
⁵ Dept. Respiratory Medicine, AZ St Jan, Brugge, Belgium
⁶ Dept. Respiratory Medicine, Université Libre, Bruxelles, Belgium
⁷ Dept. Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
⁸ Dept. Respiratory Medicine, Université Catholique de Louvain, Brussels, Belgium
⁹ Dept. Respiratory Medicine, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
¹⁰ Dept. Respiratory Medicine, University Hospital, Antwerp, Belgium
¹¹ Dept. Respiratory Medicine, Heilig Hart Ziekenhuis, Menen, Belgium
¹² Dept. Respiratory Medicine, Heilig Hart Ziekenhuis, Tienen, Belgium
¹³ Dept. Respiratory Medicine, Virga Jesse Ziekenhuis, Hasselt, Belgium
¹⁴ Dept. Respiratory Medicine, University Hospital Brussels, Brussels, Belgium
¹⁵ Dept. Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium

^* To whom correspondence should be addressed. E-mail: kurt.tournoy{at}UGent.be.

	Abstract

A clinicoradiological presentation of thoracic sarcoidosis requires histopathology to establish the diagnosis. Flexible bronchoscopy (FBX) has a reasonable diagnostic yield and is the procedure of first choice for diagnosis. Endoscopic ultrasound (EUS-FNA/EBUS-TBNA) can help to diagnose sarcoidosis. We examined prospectively in 15 clinics an implementation strategy of endoscopic ultrasound for the diagnosis of sarcoidosis after a negative FBX.

We included 137 patients (92 males, median 43 yr) and found sarcoidosis in 115 (84%). Alternative diagnoses were tuberculosis, lymphangitis carcinomatosa, pneumoconiosis and alveolitis. All patients were send for FBX, which was performed in 121 (88%) resulting in a definite diagnosis in 57 (42%). 80 patients were send for endoscopic ultrasound which could be done in 72 (90%) yielding a definite diagnosis in 47 (59%). Endoscopic ultrasound after negative FBX avoided a surgical procedure in 47/80 pts. The sensitivity of FBX for sarcoidosis was 45% (95%CI 35–54), but 62% (95%CI 50–72) if biopsies were taken. The sensitivity of endoscopic ultrasound after negative FBX was 71% (95%CI 58–82). With this strategy, 97/115 or 84% (95%CI 76–90) of proven sarcoidosis was diagnosed with endoscopy.

This large prospective implementation study shows that endoscopic ultrasound is valuable to diagnose sarcoidosis after a negative FBX. (NCT00888212).