The complimentary role of transbronchial lung cryobiopsy and endobronchial ultrasound fine needle aspiration in the diagnosis of sarcoidosis

• Published in: Respiratory medicine 2017-10, Vol.131, p.65-69
• Main Authors: Aragaki-Nakahodo, Alejandro Adolfo, Baughman, Robert P., Shipley, Ralph T., Benzaquen, Sadia
• Format: Article
• Language: English
• Subjects: Airway management; Anesthesia; Biopsy - methods; Bronchoscopy - methods; Cohort Studies; Complications; Computed tomography; Cryosurgery - methods; Diagnosis; Diagnostic systems; Endobronchial ultrasound fine needle aspiration; Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods; Evaluation; Female; Health care facilities; Humans; Lung - diagnostic imaging; Lung - pathology; Lung biopsy; Lung diseases; Male; Medical diagnosis; Medical imaging; Middle Aged; Patients; Pneumonia; Pneumothorax; Retrospective Studies; Sarcoidosis; Sarcoidosis, Pulmonary - diagnostic imaging; Sarcoidosis, Pulmonary - pathology; Tomography, X-Ray Computed; Transbronchial lung cryobiopsy; Ultrasonic imaging; Ultrasound
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2017.08.003

Transbronchial lung cryobiopsy (TBLC) is a novel technique that has proved to be useful in diagnosing various interstitial lung diseases (ILD). The use of TBLC to diagnose sarcoidosis in an unselected patient population is unknown, and could be complimentary to endobronchial ultrasound fine needle aspiration (EBUS-FNA). A retrospective analysis of 36 patients in a single, tertiary-care, academic medical center was conducted to describe the yield of both EBUS-FNA and TBLC in the diagnosis of suspected sarcoidosis over a three year period. A grading system to evaluate the presence and extent of specific radiographic features on computed tomography chest imaging studies was compared to the results of EBUS-FNA and TBLC. Complications associated with the procedures were also noted. The overall diagnostic yield in our cohort (all pathologic diagnosis considered) was 80.6% (29 out of 36 patients had a definite pathologic diagnosis). Eighteen patients referred for possible sarcoidosis had a positive bronchoscopic specimen confirming the diagnosis of sarcoidosis. For those patients with a pathologic diagnosis of sarcoidosis, the diagnostic yield for EBUS-FNA and TBLC was 66.7% each (12 out of 18 patients), while the combined diagnostic yield for EBUS-FNA and TBLC increased to 100%. For all cases, the pneumothorax rate was 11.1%. TBLC appears to be a safe and complimentary technique to diagnose sarcoidosis and could be considered part of the diagnostic armamentarium in bronchoscopic centers. •The use of transbronchial lung cryobiopsy (TBLC) to diagnose sarcoidosis is unknown.•A retrospective analysis of 36 patients describes the yield of TBLC to diagnose sarcoidosis.•The addition of TBLC to routine convex endobronchial ultrasound increased the diagnostic yield.•TBLC appears to be a safe and complimentary technique to diagnose sarcoidosis.