Technique to enable diagnosis

doi:10.1136/bmj.b3962

Published 29 September 2009, doi:10.1136/bmj.b3962
Cite this as: BMJ 2009;339:b3962

Letters

Sarcoidosis

Technique to enable diagnosis

The first 150 words of the full text of this article appear below.

Conventional flexible bronchoscopy is of limited yield in diagnosingsarcoidosis when central or peripheral airways are not affected.¹However, endobronchial ultrasound guided transbronchial needleaspiration may be helpful in patients with clinical sarcoidosisand computed tomographic evidence of accessible mediastinalnodes. We have confirmed the diagnosis of sarcoidosis usingthis technique, obviating the need for mediastinoscopy in sevenout of nine such cases (table).

View this table:

Details of nine cases of suspected sarcoidosis with mediastinal nodes undergoing EBUS-TBNA

Positive histology was regarded as the presence of non-caseatinggranulomas with negative results in fungal and mycobacterialstains and cultures, and supportive clinical findings with noother clinical explanation for the granulomas. Chest computedtomograms in all cases showed mediastinal nodes with sarcoid-likechanges without accessible parenchymal infiltrates or evidenceof endobronchial involvement.

Our findings are supported by several studies showing sensitivitiesof between 83% and 93% for endobronchial ultrasound guided transbronchialneedle . . . [Full text of this article]

Andrew R L Medford, locum consultant chest physician¹, Sanjay Agrawal, consultant respiratory intensivist², Jonathan A Bennett, consultant respiratory physician²

¹ Department of Respiratory Medicine, Glenfield Hospital, Leicester LE3 9QP, ² North Bristol Lung Centre, Southmead Hospital, Bristol BS10 5NB

andrewmedford@hotmail.com