Echotexture is a predictor of effective pathological diagnosis by endobronchial ultrasound-guided transbronchial needle aspiration in sarcoidosis: a retrospective study

Junqiang Zhang; Feng Wang; Daqing Xia; Min Xu; Weiping Pan; Lejie Cao

doi:10.36141/svdld.v42i4.16190

Authors

Junqiang Zhang Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230000, China
Feng Wang Department of Respiratory and Critical Care Medicine, Tongling People's Hospital, Tongling, Anhui 244000, China
Daqing Xia Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230000, China
Min Xu Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230000, China
Weiping Pan Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230000, China
Lejie Cao Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230000, China

Keywords:

sarcoidosis, EBUS-TBNA , pathology

Abstract

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe procedure that yields adequate samples for sarcoidosis pathology. Although pathological diagnosis is supplemented by ultrasound diagnosis, EBUS predictors of sarcoidosis remain unclear. Herein, we determine the factors predicting successful yield of EBUS-TBNA in sarcoidosis patients.

Methods: We retrospectively analyzed 113 patients with pathological or clinical sarcoidosis who underwent EBUS-TBNA for hilar or mediastinal lymphadenopathy between September 2020 and June 2022. The characteristics, including gender, age, stage, anesthetic modality, number of needle passes, size, margin, shape, echogenicity, and elastography, were documented and compared with pathological results.

Results: The pathological diagnostic yield for sarcoidosis by EBUS-TBNA was 89/113 (82.3%). Univariate analysis revealed that gender, age, stage, anesthesia, number of needle passes, size and elastography were not associated with the yield of pathological diagnosis of EBUS-TBNA. There were significant differences in margin, shape and echogenicity of lymph nodes between the groups. In a multivariate logistic analysis, echotexture of lymph node was significantly associated with successful diagnostic yield of sarcoidosis [odds ratio (OR), 9.327; 95% CI, 2.62-33.20; p= 0.001] .

Conclusion: This study has identified individuals with homogeneous lymph nodes had greater diagnostic yield for sarcoidosis by EBUS-TBNA. In general, the EBUS- echotexture of lymph nodes emerged as reliable predictors of the pathological diagnosis of sarcoidosis.

References

ADDIN EN.REFLIST Grunewald J, Grutters J, Arkema E, Saketkoo L, Moller D and Müller-Quernheim J. Publisher Correction: Sarcoidosis. Nature reviews Disease primers. 2019; 5: 49.

Yafasova A, Fosbøl E, Schou M, et al. Long-Term Adverse Cardiac Outcomes in Patients With Sarcoidosis. Journal of the American College of Cardiology. 2020; 76: 767-77.

Criado E, Sánchez M, Ramírez J, et al. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics : a review publication of the Radiological Society of North America, Inc. 2010; 30: 1567-86.

Crouser E, Maier L, Wilson K, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. American journal of respiratory and critical care medicine. 2020; 201: e26-e51.

Dziedzic D, Peryt A and Orlowski T. The role of EBUS-TBNA and standard bronchoscopic modalities in the diagnosis of sarcoidosis. The clinical respiratory journal. 2017; 11: 58-63.

Gupta D, Dadhwal D, Agarwal R, Gupta N, Bal A and Aggarwal A. Endobronchial ultrasound-guided transbronchial needle aspiration vs conventional transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest. 2014; 146: 547-56.

Kuwasaki E, Nagaoka T, Ihara H, et al. Age is an independent predictor in pathological diagnosis of sarcoidosis: a retrospective analysis of diagnosis by endobronchial ultrasound-guided transbronchial needle aspiration. Journal of thoracic disease. 2019; 11: 2175-80.

Wang L, Wu W, Hu Y, et al. Sonographic Features of Endobronchial Ultrasonography Predict Intrathoracic Lymph Node Metastasis in Lung Cancer Patients. The Annals of thoracic surgery. 2015; 100: 1203-9.

Rusch V, Asamura H, Watanabe H, Giroux D, Rami-Porta R and Goldstraw P. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2009; 4: 568-77.

Fujiwara T, Yasufuku K, Nakajima T, et al. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest. 2010; 138: 641-7.

Sun J, Yang H, Teng J, et al. Determining factors in diagnosing pulmonary sarcoidosis by endobronchial ultrasound-guided transbronchial needle aspiration. The Annals of thoracic surgery. 2015; 99: 441-5.

Grunewald J, Grutters J, Arkema E, Saketkoo L, Moller D and Müller-Quernheim J. Sarcoidosis. Nature reviews Disease primers. 2019; 5: 45.

Carbonari A, Rossini L, Marioni F, et al. Value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of lung and mediastinal lesions. Revista da Associacao Medica Brasileira (1992). 2020; 66: 1210-6.

Nakajima T, Yasufuku K, Kurosu K, et al. The role of EBUS-TBNA for the diagnosis of sarcoidosis--comparisons with other bronchoscopic diagnostic modalities. Respiratory medicine. 2009; 103: 1796-800.

Torre M, Reda M, Musso V, Danuzzo F, Mohamed S and Conforti S. Diagnostic accuracy of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for mediastinal lymph node staging of lung cancer. Mediastinum (Hong Kong, China). 2021; 5: 15.

Sharma S, Dominguez A and Lustgarten J. High accumulation of T regulatory cells prevents the activation of immune responses in aged animals. Journal of immunology (Baltimore, Md : 1950). 2006; 177: 8348-55.

Lin C, Chang L, Yu K, Wen Y, Fan H and Ho C. Differentiating metastatic lymph nodes in lung cancer patients based on endobronchial ultrasonography features. Medical ultrasonography. 2018; 20: 154-8.

Alici I, Yılmaz Demirci N, Yılmaz A, Karakaya J and Özaydın E. The sonographic features of malignant mediastinal lymph nodes and a proposal for an algorithmic approach for sampling during endobronchial ultrasound. The clinical respiratory journal. 2016; 10: 606-13.

Gu Y, Shi H, Su C, et al. The role of endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph nodes. Oncotarget. 2017; 8: 89194-202.

Dhooria S, Agarwal R, Aggarwal A, Bal A, Gupta N and Gupta D. Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: a study of 165 patients. The Journal of thoracic and cardiovascular surgery. 2014; 148: 662-7.

Ayub I, Mohan A, Madan K, et al. Identification of specific EBUS sonographic characteristics for predicting benign mediastinal lymph nodes. The clinical respiratory journal. 2018; 12: 681-90.

Evison M, Morris J, Martin J, et al. Nodal staging in lung cancer: a risk stratification model for lymph nodes classified as negative by EBUS-TBNA. Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer. 2015; 10: 126-33.

He H, Chen J, Ma H, Zhu J, Wu D and Lv X. Value of Endobronchial Ultrasound Elastography in Diagnosis of Central Lung Lesions. Medical science monitor: international medical journal of experimental and clinical research. 2017; 23: 3269-75.

Sun J, Zheng X, Mao X, et al. Endobronchial Ultrasound Elastography for Evaluation of Intrathoracic Lymph Nodes: A Pilot Study. Respiration; international review of thoracic diseases. 2017; 93: 327-38.

Izumo T, Sasada S, Chavez C, Matsumoto Y and Tsuchida T. Endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph nodes. Japanese journal of clinical oncology. 2014; 44: 956-62.

He H, Huang M, Zhu J, Ma H and Lyu X. Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes. Chinese medical journal. 2015; 128: 2720-5.

Di Felice C, Young B and Matta M. Comparison of specimen adequacy and diagnostic accuracy of a 25-gauge and 22-gauge needle in endobronchial ultrasound-guided transbronchial needle aspiration. Journal of thoracic disease. 2019; 11: 3643-9.

Tyan C, Patel P, Czarnecka K, et al. Flexible 19-Gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Needle: First Experience. Respiration; international review of thoracic diseases. 2017; 94: 52-7.

Yarmus L, Akulian J, Gilbert C, et al. Optimizing endobronchial ultrasound for molecular analysis. How many passes are needed? Annals of the American Thoracic Society. 2013; 10: 636-43.

Oki M, Saka H, Ando M, et al. How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study. Respiration; international review of thoracic diseases. 2018; 95: 251-7.

Mohan A, Iyer H, Madan K, et al. A randomized comparison of sample adequacy and diagnostic yield of various suction pressures in EBUS-TBNA. Advances in respiratory medicine. 2021; 89: 268-76.

Vasugi G, Mathivanan K, Rajendiran S, Sundaram S and Ayub I. Traveling with ROSE in EBUS-TBNA - Experience from a Tertiary Care Hospital in South India. Journal of cytology. 2021; 38: 175-9.

Navasakulpong A, Auger M and Gonzalez A. Yield of EBUS-TBNA for the diagnosis of sarcoidosis: impact of operator and cytopathologist experience. BMJ open respiratory research. 2016; 3: e000144.