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A Journal on Internal Medicine

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Minerva Medica 2015 April;106(2 Suppl 2):1-7


language: English

Bronchoscopy in sarcoidosis: union is strength

Mandoni M. 1, Radovanovic D. 2, Valenti V. 3, Patella V. 4, Santus P. 2

1 Respiratory Unit, San Paolo Hospital, Milan, Italy; 2 Dipartimento di Scienze della Salute, Università degli Studi di Milano, Pulmonary Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan-IRCCS, Milan, Italy; 3 Department of Biomedical Sciences for Health Università degli Studi di Milano, Respiratory Unit, Policlinico San Donato IRCCS, San Donato Milanese, Italy; 4 Division of Allergy and Clinical Immunology Battipaglia Hospital, ASL Salerno, Salerno, Italy


Sarcoidosis is a benign disease of unknown etiology that is characterized by the formation of noncaseating epithelioid cell granulomas. Although a multisystemic disease, it primarily affects the lung and the lymphatic system of the body. When a histological diagnosis is required, bronchoscopy is frequently employed because allows tissue sampling from several anatomic sources, such as airways, lung parenchyma and hilar/mediastinal nodes. Transbronchial lung biopsies (TBLB), endobronchial biopsies (EBB) and conventional transbronchial needle aspiration (cTBNA) have long been the only bronchoscopic techniques to diagnose sarcoid granulomas, until the advent of endobronchial ultrasound guided needle aspiration (EBUS-TBNA). This technique shows excellent yield in sampling mediastinal adenopathies with a higher sensitivity than the conventional technique in sarcoidosis as well. Furthermore, non controlled studies, demonstrated its diagnostic superiority than EBB and TBLB in stages I (hilar adenopathies only) and II (hilar lymph nodes and parenchymal infiltrations) thoracic sarcoidosis. In a recent study, Gupta et al., randomized 130 patients with suspected stage I and II disease to undergo EBUS-TBNA or cTBNA in conjunction with transbronchial and endobronchial biopsies. The Authors demonstrated that the yield of cTBNA added to EBB and TBLB is similar to EBUS-TBNA plus transbronchial biopsies, although ultrasound guided transbronchial needle aspiration shows the best single diagnostic efficacy. In this review article we aimed to discuss the findings by Gupta in the context of medical literature, highlighting the importance of adding nodal aspirations (with or without ultrasound guidance) with bronchial and transbronchial samples to gain the optimal sensitivity in obtaining histological confirmation. We finally pointed out the need for future studies to evaluate the potential role of rapid on-site evaluation (ROSE) of needle aspirates in reducing additional sampling and related costs and complications.

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Mandoni M, Radovanovic D, Valenti V, Patella V, Santus P. Bronchoscopy in sarcoidosis: union is strength. Minerva Med 2015 April;106(2 Suppl 2):1-7. 

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