• A Kitamura, Y Takiguchi, K Kurosu, N Takigawa, F Saegusa, K Hiroshima, T Nakajima, N Tanabe, Y Nakatani, I Yoshino, and K Tatsumi.
• Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
• Sarcoidosis Vasc Dif. 2012 Oct 1;29(2):82-9.

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic value in sarcoidosis if the obtained histological specimen is indicative of a non-caseating epithelioid-cell granuloma. However, EBUS-TBNA in sacoidosis sometimes affords solely cytological specimens.ObjectiveTo investigate the relevance of EBUS-TBNA cytology specimens in diagnosing sarcoidosis.DesignThe study population comprised 72 patients with sarcoidosis and 116 patients who had thoracic malignancies and intrathoracic lymphadenopathy but were eventually proven to be metastasis-free (controls). The EBUS-TBNA samples obtained for these subjects were blindly evaluated for the presence of epithelioid cell clusters by 2 independent cytoscreeners and a pathologist.ResultsInterobserver variability in the specimen grading was minimal. The sensitivity and specificity were 65.3% and 94.0%, respectively. The sensitivity was high, at 87.5%, for the combined cytological and histological examinations. Of 7 controls whose cytological specimens showed epithelioid cell clusters, 3 were also deemed positive for sarcoidosis on histological examination, which indicated that they had sarcoid reaction to cancer.ConclusionsCytological evaluation of the EBUS-TBNA specimens had higher sensitivity than histological evaluation alone for intrathoracic lymphadenopathy due to sarcoidosis. It should be recognized, however, that up to 6% of patients with thoracic malignancy may have sarcoid reaction in non-metastatic lymph nodes.

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