Diagnosis of intra-abdominal and mediastinal sarcoidosis with EUS-guided FNA

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• 作者：Hazar Michael ; Sammy Ho ; Bonnie Pollack ; Mala Gupta ; Frank Gress
• 刊名：Gastrointestinal Endoscopy
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：67
• 期：1
• 页码：28-34
• 全文大小：670 K

文摘

Background

In the presence of a compatible clinical picture, the diagnosis of sarcoidosis requires pathologic confirmation of noncaseating epithelioid granuloma in affected tissues. The standard procedure of choice for most patients is a bronchoscopy with transbronchial biopsy (TBB), which has a diagnostic yield of 40 % to 90 % . The lowest yield with TBB is in cases that present with predominant mediastinal or intra-abdominal lymphadenopathy (LN) and minimal parenchymal lung involvement.

Objective

To study the diagnostic yield of EUS-guided FNA in diagnosing sarcoidosis with predominant LN or masses.

Design

Retrospective chart review.

Setting

Teaching university hospital.

Patients

Analysis of 21 consecutive patients with sarcoidosis and predominant mediastinal and/or intra-abdominal LN or masses who underwent EUS-guided FNA.

Results

EUS-guided FNA diagnosed sarcoidosis in 18 of 21 patients (86 % ). In 3 patients, EUS-guided FNA was either not diagnostic or inconclusive, and patients underwent mediastinoscopy with lymphadenectomy, which established the diagnosis of sarcoidosis. Seven of the 21 patients (33 % ) had intra-abdominal LN and/or masses, and EUS-guided FNA of the intra-abdominal pathology was diagnostic of sarcoidosis in 4 of the 7 patients (57 % ). Four of the 21 patients (19 % ) had a history of malignancy, and use of EUS-guided FNA helped in ruling out the recurrence of malignancy in 3 of the 4 patients (75 % ).

Limitations

Mycobacterial and fungal culture was not obtained in all patients.

Conclusions

EUS-guided FNA offers a practical, minimally invasive technique for the diagnosis of sarcoidosis in patients who present with predominant mediastinal and/or intra-abdominal LN or masses.