Transbronchial Needle Aspiration for Diagnosis of Sarcoidosis

Abstract

Histologic diagnosis, necessary for many patients with sarcoidosis, is often obtained by bronchoscopy because pulmonary or mediastinal involvement occurs in 80% to 90%. Transbronchial needle aspiration (TBNA), transbronchial biopsy (TBB), endobronchial biopsy (EBB), and bronchoalveolar lavage (BAL) have decreased the necessity for mediastinoscopy, thoracoscopy, and open lung biopsy. TBNA using rigid 18- or flexible 19-gauge needles can provide the specimens for histology with a yield of 46% to 90% overall. It provides a higher diagnostic yield (∼70%) in stage I than in stage II (∼45%) and has a sensitivity and accuracy of ∼55%, and a specificity and positive predictive value of 100% similar to EBB. Its negative predictive value is low as is that of EBB or TBB (all less than 20%). Cytologic diagnosis of sarcoidosis, including that by TBNA, is reliable but underused. Both histologic and cytologic diagnoses are nonspecific. Compared with TBB and surgical procedures, TBNA has minimal complications: usually a few milliliters of bleeding and no major complications. In conclusion, TBNA is efficient and safe in symptomatic or atypical stage I cases, stage II cases with lymphadenopathy and pulmonary pseudonodules or masses, and stage III cases with pulmonary pseudonodules or masses.