Role of additional endobronchial biopsy in enhancing diagnostic accuracy for sarcoidosis

Tomo Tsunoda; Yoshiyuki  Oyama; Tomotsugu Nuki; Taisuke Ito; Rie Mori; Takuro Akashi; Kazuo Tsuchiya; Masaki Ikeda

doi:10.36141/svdld.vi.16166

Authors

Tomo Tsunoda Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Yoshiyuki Oyama Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Tomotsugu Nuki Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Taisuke Ito Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Rie Mori Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Takuro Akashi Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Kazuo Tsuchiya Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital
Masaki Ikeda Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital

Keywords:

sarcoidosis, endobronchial biopsy, diagnostic yield

Abstract

Background and Aim: The identification of nonnecrotizing granulomas is essential for the diagnosisof sarcoidosis. For this purpose, the effectiveness of transbronchial lung biopsy (TBLB) and transbronchial needle aspiration (TBNA) is established; however, the role of endobronchial biopsy (EBB) remains uncertain. This study aimed to assess the additional diagnostic value of EBB and factors affecting its diagnostic yield for the diagnosis of sarcoidosis.

Methods: This retrospective cross-sectional study included 46 patients who were preliminarily diagnosed with sarcoidosis and admitted to the Department of Respiratory Medicine of Shizuoka Saiseikai General Hospital between August 2016 and April 2023. Among them, 25 patients who underwent EBB were divided into EBB (diagnosed by EBB) and nonEBB (diagnosed by TBLB, TBNA, or clinically) groups. The patient background characteristics were analyzed to identify factors affecting the diagnostic yield of EBB.

Results: The diagnostic yield of EBB alone was 24% (6 of 25 patients). There were no significant differences in the patients’ background characteristics between the two groups. When EBB was added, the diagnostic yield of TBLB increased from 47.8% to 60.9% and that of TBNA increased from 52.6% to 57.9%. In three patients, EBB alone provided histological diagnosis.

Conclusions: Although EBB alone had a relatively low diagnostic yield, it led to a diagnosis in some cases. Combining TBLB or TBNA with EBB may enhance overall diagnostic yield.

References

1. Armstrong JR, Rajke JR, Kvale PA, et al. Endoscopic findings in sarcoidosis: characteristics and correlations with radiographic staging and bronchial mucosa yield. Ann Otol Rhinol Laryngol. 1981;90:339-43. doi: 10.1177/000348948109000410.

2. Bjemer L, Thunell M, Rosenhall L, et al. Endobronchial biopsy positive sarcoidosis: relation to bronchoalveolar lavage and course of disease. Respir Med. 1991;85:229-34. doi: 10.1016/s0954-6111(06)80085-5.

3. Bilaceroglu S, Perim K, Gunel O, et al. Combining transbronchial aspiration with endobronchial and transbronchial biopsy in sarcoidosis. Monaldi Arch Chest Dis. 1999;54:217-23. PMID: 10441973.

4. Shorr AF, Torrington KG, Hnatiuk OW, et al. Endobronchial biopsy for sarcoidosis: a prospective study. Chest. 2001;120:109-14. doi: 10.1378/chest.120.1.109.

5. Benzaquen S, Aragaki-Nakahodo AA. Bronchoscopic modalities to diagnose sarcoidosis. Curr Opin Pulm Med. 2017;23:433-8. doi: 10.1097/MCP.0000000000000398.

6. Trisolini R, Lazzari Agli L, Tinelli C, De Silvestri A, Scotti V, Patelli M.Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations. Respirology. 2015;20:226-34. doi: 10.1111/resp.12449.

7. American Thoracic Society, European Respiratory Society, World Association of Sarcoidosis and Other Granulomatous Disorders. Statement on sarcoidosis. Am J Respir Crit Care Med. 1999;160:736-55. doi: 10.1164/ajrccm.160.2.ats4-99.

8. The Japanese Society of Sarcoidosis and Other Granulomatous Disorders. Diagnostic standard and guideline for sarcoidosis-2006. Jpn J Sarcoidosis Granulomatous Disord. 2007;27:89-102.

9. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48:452-8. doi: 10.1038/bmt.2012.244.

10. Dziedzic DA, Peryt A, Orlowski T. The role of EBUS-TBNA and standard bronchoscopic modalities in the diagnosis of sarcoidosis. Clin Respir J. 2017;11:58-63. doi: 10.1111/crj.12304.

11. Torrington KG, Shorr AF, Parker JW. Endobronchial disease and racial differences in pulmonary sarcoidosis. Chest. 1997;111:619-22. doi: 10.1378/chest.111.3.619.

12. Ishii H, Otani S, Iwata A, et al. Limited role of auxiliary endobronchial biopsy in the diagnosis of Japanese patients with sarcoidosis. Tohoku J Exp Med. 2011;223:119-23. doi: 10.1620/tjem.223.119.

13. Scadding JG, Mitchell DN. Sarcoidosis. London: Chapman and Hall; 1985.

14. Inoue Y, Inui N, Suda T, et al. Cumulative incidence and predictors of progression in corticosteroid-naïve patients with sarcoidosis. PLoS One. 2015;10(11):e0143371. doi: 10.1371/journal.pone.0143371.