Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think?

S. M. Wildi, M. A. Judson, M. Fraig, W. E. Fickling, N. Schmulewitz, S. Varadarajulu, S. S. Roberts, P. Prasad, R. H. Hawes, M. B. Wallace, B. J. Hoffman

Research output: Contribution to journalArticle

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Abstract

Background: Preliminary data show that endosonography guided fine needle aspiration (EUS-FNA) may be an accurate method for diagnosing sarcoidosis. However, these data were obtained in a small selected group of patients with a very high pretest probability of sarcoidosis. This retrospective study reports on the use of EUS-FNA in an unselected group of patients with mediastinal lymphadenopathy of unknown origin. Methods: The EUS database of a single tertiary referral centre was reviewed for patients who underwent EUS-FNA for mediastinal lymphadenopathy of unknown origin. Clinical presentation and imaging studies of each case were carefully reviewed and the diagnosis "sarcoidosis" or "no sarcoidosis" attributed if possible. The diagnoses were compared with the result of EUS-FNA. Results: One hundred and twenty four patients were investigated. In 35 cases EUS-FNA identified granulomas (group 1); in the other 89 cases (group 2) no granulomas were detected. The definite diagnoses in group 1 were sarcoidosis (n = 25), indefinite (n = 7), no sarcoidosis (n = 3). The definite diagnoses in group 2 were sarcoidosis (n = 3), indefinite (n = 9), no sarcoidosis (n = 77). Of the 77 cases with no sarcoidosis, 44 were diagnosed with other diseases. The other 33 showed non-specific changes in the FNA and sarcoidosis was excluded by negative non-EUS pathology (n = 17) and clinical presentation. The sensitivity and specificity for EUS-FNA were 89% (95% CI 82 to 94) and 96% (95% CI 91 to 98), respectively, after exclusion of the indefinite cases in both groups. Conclusions: EUS-FNA is an accurate method for diagnosing sarcoidosis in an unselected group of patients with mediastinal lymphadenopathy. The reported sensitivity and specificity must be appreciated in the context of the difficult and often incomplete clinical diagnosis of sarcoidosis.

Original languageEnglish (US)
Pages (from-to)794-799
Number of pages6
JournalThorax
Volume59
Issue number9
DOIs
StatePublished - Sep 2004
Externally publishedYes

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Sarcoidosis
Fine Needle Biopsy
Granuloma
Sensitivity and Specificity
Tertiary Care Centers

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Wildi, S. M., Judson, M. A., Fraig, M., Fickling, W. E., Schmulewitz, N., Varadarajulu, S., ... Hoffman, B. J. (2004). Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think? Thorax, 59(9), 794-799. https://doi.org/10.1136/thx.2003.009472

Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think? / Wildi, S. M.; Judson, M. A.; Fraig, M.; Fickling, W. E.; Schmulewitz, N.; Varadarajulu, S.; Roberts, S. S.; Prasad, P.; Hawes, R. H.; Wallace, M. B.; Hoffman, B. J.

In: Thorax, Vol. 59, No. 9, 09.2004, p. 794-799.

Research output: Contribution to journalArticle

Wildi, SM, Judson, MA, Fraig, M, Fickling, WE, Schmulewitz, N, Varadarajulu, S, Roberts, SS, Prasad, P, Hawes, RH, Wallace, MB & Hoffman, BJ 2004, 'Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think?', Thorax, vol. 59, no. 9, pp. 794-799. https://doi.org/10.1136/thx.2003.009472
Wildi SM, Judson MA, Fraig M, Fickling WE, Schmulewitz N, Varadarajulu S et al. Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think? Thorax. 2004 Sep;59(9):794-799. https://doi.org/10.1136/thx.2003.009472
Wildi, S. M. ; Judson, M. A. ; Fraig, M. ; Fickling, W. E. ; Schmulewitz, N. ; Varadarajulu, S. ; Roberts, S. S. ; Prasad, P. ; Hawes, R. H. ; Wallace, M. B. ; Hoffman, B. J. / Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think?. In: Thorax. 2004 ; Vol. 59, No. 9. pp. 794-799.
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abstract = "Background: Preliminary data show that endosonography guided fine needle aspiration (EUS-FNA) may be an accurate method for diagnosing sarcoidosis. However, these data were obtained in a small selected group of patients with a very high pretest probability of sarcoidosis. This retrospective study reports on the use of EUS-FNA in an unselected group of patients with mediastinal lymphadenopathy of unknown origin. Methods: The EUS database of a single tertiary referral centre was reviewed for patients who underwent EUS-FNA for mediastinal lymphadenopathy of unknown origin. Clinical presentation and imaging studies of each case were carefully reviewed and the diagnosis {"}sarcoidosis{"} or {"}no sarcoidosis{"} attributed if possible. The diagnoses were compared with the result of EUS-FNA. Results: One hundred and twenty four patients were investigated. In 35 cases EUS-FNA identified granulomas (group 1); in the other 89 cases (group 2) no granulomas were detected. The definite diagnoses in group 1 were sarcoidosis (n = 25), indefinite (n = 7), no sarcoidosis (n = 3). The definite diagnoses in group 2 were sarcoidosis (n = 3), indefinite (n = 9), no sarcoidosis (n = 77). Of the 77 cases with no sarcoidosis, 44 were diagnosed with other diseases. The other 33 showed non-specific changes in the FNA and sarcoidosis was excluded by negative non-EUS pathology (n = 17) and clinical presentation. The sensitivity and specificity for EUS-FNA were 89{\%} (95{\%} CI 82 to 94) and 96{\%} (95{\%} CI 91 to 98), respectively, after exclusion of the indefinite cases in both groups. Conclusions: EUS-FNA is an accurate method for diagnosing sarcoidosis in an unselected group of patients with mediastinal lymphadenopathy. The reported sensitivity and specificity must be appreciated in the context of the difficult and often incomplete clinical diagnosis of sarcoidosis.",
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AU - Fraig, M.

AU - Fickling, W. E.

AU - Schmulewitz, N.

AU - Varadarajulu, S.

AU - Roberts, S. S.

AU - Prasad, P.

AU - Hawes, R. H.

AU - Wallace, M. B.

AU - Hoffman, B. J.

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N2 - Background: Preliminary data show that endosonography guided fine needle aspiration (EUS-FNA) may be an accurate method for diagnosing sarcoidosis. However, these data were obtained in a small selected group of patients with a very high pretest probability of sarcoidosis. This retrospective study reports on the use of EUS-FNA in an unselected group of patients with mediastinal lymphadenopathy of unknown origin. Methods: The EUS database of a single tertiary referral centre was reviewed for patients who underwent EUS-FNA for mediastinal lymphadenopathy of unknown origin. Clinical presentation and imaging studies of each case were carefully reviewed and the diagnosis "sarcoidosis" or "no sarcoidosis" attributed if possible. The diagnoses were compared with the result of EUS-FNA. Results: One hundred and twenty four patients were investigated. In 35 cases EUS-FNA identified granulomas (group 1); in the other 89 cases (group 2) no granulomas were detected. The definite diagnoses in group 1 were sarcoidosis (n = 25), indefinite (n = 7), no sarcoidosis (n = 3). The definite diagnoses in group 2 were sarcoidosis (n = 3), indefinite (n = 9), no sarcoidosis (n = 77). Of the 77 cases with no sarcoidosis, 44 were diagnosed with other diseases. The other 33 showed non-specific changes in the FNA and sarcoidosis was excluded by negative non-EUS pathology (n = 17) and clinical presentation. The sensitivity and specificity for EUS-FNA were 89% (95% CI 82 to 94) and 96% (95% CI 91 to 98), respectively, after exclusion of the indefinite cases in both groups. Conclusions: EUS-FNA is an accurate method for diagnosing sarcoidosis in an unselected group of patients with mediastinal lymphadenopathy. The reported sensitivity and specificity must be appreciated in the context of the difficult and often incomplete clinical diagnosis of sarcoidosis.

AB - Background: Preliminary data show that endosonography guided fine needle aspiration (EUS-FNA) may be an accurate method for diagnosing sarcoidosis. However, these data were obtained in a small selected group of patients with a very high pretest probability of sarcoidosis. This retrospective study reports on the use of EUS-FNA in an unselected group of patients with mediastinal lymphadenopathy of unknown origin. Methods: The EUS database of a single tertiary referral centre was reviewed for patients who underwent EUS-FNA for mediastinal lymphadenopathy of unknown origin. Clinical presentation and imaging studies of each case were carefully reviewed and the diagnosis "sarcoidosis" or "no sarcoidosis" attributed if possible. The diagnoses were compared with the result of EUS-FNA. Results: One hundred and twenty four patients were investigated. In 35 cases EUS-FNA identified granulomas (group 1); in the other 89 cases (group 2) no granulomas were detected. The definite diagnoses in group 1 were sarcoidosis (n = 25), indefinite (n = 7), no sarcoidosis (n = 3). The definite diagnoses in group 2 were sarcoidosis (n = 3), indefinite (n = 9), no sarcoidosis (n = 77). Of the 77 cases with no sarcoidosis, 44 were diagnosed with other diseases. The other 33 showed non-specific changes in the FNA and sarcoidosis was excluded by negative non-EUS pathology (n = 17) and clinical presentation. The sensitivity and specificity for EUS-FNA were 89% (95% CI 82 to 94) and 96% (95% CI 91 to 98), respectively, after exclusion of the indefinite cases in both groups. Conclusions: EUS-FNA is an accurate method for diagnosing sarcoidosis in an unselected group of patients with mediastinal lymphadenopathy. The reported sensitivity and specificity must be appreciated in the context of the difficult and often incomplete clinical diagnosis of sarcoidosis.

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