Does Endobronchial Ultrasound-guided transbronchial needle aspiration (EBUS) alter the diagnosis in suspected Sarcoidosis?

EBUS is now used routinely in the investigation of sarcoidosis. If the pre-test CT diagnosis is sarcoidosis, it is not clear how often EBUS changes the diagnosis or management. We performed a retrospective analysis of patients referred for EBUS with possible sarcoidosis in a 24 month period.A total of 75 patients were identified. The median age was 52 years, 65% were males and 69% were white British. Patients were split into 2 groups based on the CT report - Typical of Sarcoidosis and Possible Sarcoidosis. We also looked at the number of nodes sampled. 47 patients had CT scans reported as Typical Sarcoidosis. EBUS gave results consistent with sarcoidosis in 24/47 patients (51%) and whilst 8 had other investigations, it did not change the diagnosis. The final diagnosis was sarcoid in all of this group. 28 patients were in the group with Possible Sarcoidosis. Where sarcoidosis was the most likely differential diagnosis (18/28), 8 of them had an EBUS consistent with sarcoidosis. The final diagnosis was sarcoidosis in 13 of this group (46%). In all cases diagnosed with sarcoid (n=60), the number of nodes sampled to that gave a result consistent with sarcoidosis were: 1 node - 32% (8 out of 27 patients), 2 nodes - 61% (22 out of 36 patients). 3 nodes 100% (9 out of 9 patients) EBUS has an important role in the investigation of sarcoidosis. This analysis showed greater benefit in patients with CT reported as possible rather than typical sarcoidosis. When EBUS is performed, the greater number of lymph nodes sampled improves the diagnostic yield.