A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis.

Author(s): Tremblay A, Stather DR, Maceachern P, Khalil M, Field SK

Affiliation(s): From the Division of Respiratory Medicine (Drs. Tremblay, Stather, MacEachern, and Field) and the Department of Pathology and Laboratory Medicine (Dr. Khalil), University of Calgary, Calgary, AB, Canada.

Publication date & source: 2009-02-02, Chest., [Epub ahead of print]

Publication type:

Background Ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes (EBUS-TBNA) has been found to be more accurate than standard transbronchial needle aspiration (TBNA) in the setting of malignancy. In patients with suspected sarcoidosis, the smaller ultrasound needle may yield inadequate material to make a histologic diagnosis of granulomatous inflammation. The aim of this study was to compare the diagnostic yield of EBUS-TBNA to standard 19-gauge (g) TBNA in patients with mediastinal adenopathy and a clinical suspicion of sarcoidosis. Methods A randomized controlled trial was performed in a University medical center, enrolling fifty patients (of 61 screened: 2 declined, 9 did not meet entry criteria) with hilar and/or mediastinal adenopathy and a clinical suspicion of sarcoidosis. Twenty four patients were randomized to undergo EBUS-TBNA and 26 to standard 19 g TBNA. Results The primary outcome measure of diagnostic yield was 53.8% vs 83.3% in favor of the EBUS-TBNA group, an absolute increase of 29.5% (p < 0.05; 95% CI 8.6%-55.4%). After blinded research pathology review, diagnostic yield was 73.1% vs 95.8%, in favor of the EBUS-TBNA group, an absolute increase of 22.7% (p = 0.05, 95% CI 1.9% to 42.2%). Sensitivity and specificity were 60.9% and 100% in the standard TBNA group and 83.3% and 100% in the EBUS-TBNA group (22.5% absolute increase in sensitivity; p = 0.085; 95% CI -3.2% to 44.9%), respectively. Conclusions The diagnostic yield of EBUS-TBNA is superior to 19 g standard TBNA for sampling of mediastinal lymph nodes in patients with a clinical suspicion of sarcoidosis. Trial Registration ClinicalTrials.gov identifier NCT00373555.