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

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.

Abbreviations: ACE, angiotensin-converting enzyme, LN, lymphadenopathy, TBB, transbronchial biopsy, TBNA, transbronchial needle aspiration, VATS, video-assisted thoracoscopic lung biopsy