ORIGINAL ARTICLE   

Minerva Respiratory Medicine 2023 June;62(2):61-8

DOI: 10.23736/S2784-8477.21.01972-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Endobronchial mucosal biopsy in patients with suspected pulmonary sarcoidosis

Ahmed M. ABDELHADY ✉, Mona S. ALHOUSHY, Alaa A. ABD ALLAH, Abdelrahman M. KHEDR

Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt

BACKGROUND: Sarcoidosis affects the lung in more than 90% of cases, but also affect any organ of the body. The bronchoscope allows for several different diagnostic samples; however, bronchoscopists often underestimate the value of endobronchial biopsy (EBB) in the histological confirmation of sarcoidosis.
METHODS: We included 20 patients having suspected pulmonary sarcoidosis (based on clinical and radiological presentation) and being ≥18 years of age. All included patients were subjected to flexible bronchoscopy. Any abnormal endoscopic findings suggestive of endobronchial sarcoidosis was reported. Bronchoalveolar lavage and endobronchial biopsies were obtained.
RESULTS: EBB was positive for characteristic non-caseating granuloma of sarcoidosis in 10 patients with a diagnostic yield of 50%. The pathological yield was statistically correlated with the presence of endobronchial mucosal abnormalities but not with the radiological stage. Bronchoalveolar lavage (BAL) was predominantly lymphocytic in 16 (80%) cases, only in 4 (20%) cases their lavage was neutrophilic. There was no statically significant relationship between differential cell count and the biopsy result. The mean value for CD4/CD8 ratio was 1.24±0.45. There was statically significant relationship between CD4/CD8 count in the BAL and the result of mucosal biopsy. The CD4/CD8 count was higher in positive cases with a mean value of 1.46±0.44.
CONCLUSIONS: This study provides circumstantial evidence that endobronchial involvement is common in sarcoidosis and EBB can increase the yield of fiber optic diagnosis of sarcoidosis with high diagnostic ratio in cases with mucosal abnormalities. A normal looking endobronchial mucosa should not stop the bronchoscopists from performing EBB.

KEY WORDS: Sarcoidosis; Bronchoscopy; Endoscopic mucosal resection