Тhe value of transbronchial needle aspiration cytology in the diagnosis of stage I and II sarcoidosis

Željka Tatomirović; Vesna Škuletić; Dragana Peković; Vukoica Karličić; Branka Djurović; Saša Ristić; Ljiljana Tomić; Jelena Džambas; Snežana Cerović

doi:10.2298/VSP151105080T

Željka Tatomirović Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Vesna Škuletić Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Dragana Peković Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Vukoica Karličić Military Medical Academy, Clinic for Pulmonary Disease, Belgrade, Serbia.
Branka Djurović Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Institute for Occupational Medicine, Belgrade, Serbia.
Saša Ristić Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia.
Ljiljana Tomić Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia.
Jelena Džambas Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia.
Snežana Cerović Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP151105080T

Keywords: sarcoidosis, diagnosis, differential, lymph nodes, mediastinum, biopsy, fine-needle, sensitivity and specificity,

Abstract

Background/Aim. Sarcoidosis is a multisystem infmammatory disease of unknown etiology, with the lungs and intrathoracic lymph nodes the most commonly involved. The aim of this study was to assess the contribution of conventional transbronchial needle aspiration (TBNA) cytology in the diagnosis of sarcoidosis presenting as mediastinal/hilar lymphadenopathy. Methods. In this retrospective study, 58 patients with suspicion of stage I and II sarcoidosis underwent first flexibile, and then, a rigid bronhoscopy, during which TBNA of mediastinal or hilar lumph node with a 19 gauge (G) needle was done. Material from the needle was put on glass slide and prepared for the cytological and histopathological examination. Results. Out of 58 patients submitted to TBNA of mediastinal or hilar lymph nodes, adequate material for cytological diagnostics was obtained in 53 (91.37%). Out of 53 adequate cytological samples, in 38 (71.69%) noncaseous granulomatous inflammation (NGI) was found, while in corresponding histopathological samples, NGI was found in 48 (90.56%), which was significantly higher (p < 0.05). Of cytological smears, out of the cell types typical for granulomatous inflammation, in 26 (63.15%) patients the clusters of the epitheloid cells were found, in 8 (21.05%) there were both, clusters of epitheloid cells and giant multinuclear hystiocytes, and in 6 (15.76%) only single scattered epitheloid cells or small clusters of several epitheloid cells were found. The sensitivity of TBNA cytology in our group of patients with sarcoidosis was 76%, specificity 100% and accuracy 77.34%. Conclusion. TBNA is an efficient and safe procedure in the diagnosis of sarcoidosis, minimally invasive and with a little risk of complications. Using 19 G needle enables obtaining material for histological and cytological analyses, as well which contribute to the sensitivity of diagnosting sarcoidosis. The value of this type of diagnostics depends on qualification and experience both of bronchoscopist and cytologist/pathologist, as well, of the interpreter of such a material.

References

Marc AJ. Advances in the diagnosis and treatment of sarcoidosis. F1000Prime Rep2014, 6: 89.

Chen ES, Song Z, Willett MH, Heine S, Yung RC, Liu MC, et al. Serum amyloid A regulates granulomatous inflammation in sarcoidosis through Toll-like receptor-2. Am J Respir Crit Care Med 2010; 181(4): 360−73.

Costabel U, Hunninghake GW. ATS/ERS/WASOG statement on sarcoidosis. Sarcoidosis Statement Committee. American Thoracic Society. European Respiratory Society. World Asso-ciation for Sarcoidosis and Other Granulomatous Disorders. Eur Respir J 1999; 14(4): 735−7.

Mukhopadhyay S, Gal AA. Granulomatous lung disease: An ap-proach to the differential diagnosis. Arch Pathol Lab Med 2010; 134(5): 667−90.

Agarwal R, Aggarwal AN, Gupta D. Efficacy and safety of con-ventional transbronchial needle aspiration in sarcoidosis: A systematic review and meta- analysis. Respir Care 2013; 58(4): 683−93.

Baker JJ, Solanki PH, Schenk DA, Van Pelt C, Ramzy I. Transbronchial fine needle aspiration of the mediastinum. Im-portance of lymphocytes as an indicator of specimen adequa-cy. Acta Cytol 1990; 34(4): 517−23.

Annema JT, Veseliç M, Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Eur Respir J 2005; 25(3): 405−9.

Gnass M, Szlubowski A, Soja J, Kocoń P, Rudnicka L, Ćmiel A, Kużet al. Comaparison of conventional and ultrasound-guided needle biopsy techniques in the diagnosis of sarcoidosis: A randomized trial. Pol Arch Med Wewn 2015; 125(5): 321−8.

Ribeiro C, Oliveira A, Neves S, Campainha S, Nogueira C, Torres S, et al. Diagnosis of sarcoidosis in the endobronchial ultra-sound-guided transbronchial needle asoiration. Rev Port Pneumol 2014; 20(5): 237−41.

Navani N, Booth HL, Kocjan G, Falzon M, Capitanio A, Brown JM, et al. Combination of endobronchial ultrasound-guided trans-bronchial needle aspiration with standard bronchoscopic tech-niques for the diagnosis of stage I and stage II pulmonary sar-coidosis. Respirology 2011; 16(3): 467−72.

Schieppati E. Mediastinal puncture thru the tracheal carina. Rev Asoc Med Argent 1949; 63(663−664): 497−8. (Spanish)

Wang KP, Terry P, Marsh B. Bronchoscopic needle aspiration biopsy of paratracheal tumors. Am Rev Respir Dis 1978; 118(1): 17−21.

Smyth CM, Stead RJ. Survey of flexible fibreoptic bronchoscopy in the United Kingdom. Eur Respir J 2002; 19(3): 458–63.

Dasgupta A, Mehta AC. Transbronchial needle aspiration. An underused diagnostic technique. Clin Chest Med 1999; 20(1): 39−51.

Hsu L, Liu C, Ko J. Education and experience improve the per-formance of transbronchial needle aspiration: A learning curve at a cancer center. Chest 2004; 125(2): 532−40.

Trisolini R, Tinelli C, Cancellieri A, Paioli D, Alifano M, Boaron M, et al. Tronsbronchial needle aspiration in sarcoidosis: Yield and predictors of a positive aspirate. J Thoracic Cardiovasc Surg 2008; 135(4): 837−42.

Morales CF, Patefield AJ, Strollo PJ, Schenk DA. Flexible trans-bronchial needle aspiration in the diagnosis of sarcoidosis. Chest 1994; 106(3): 709−11.

Tremblay A, Stather DR, MacEachern P, Khalil M, Field SK. A randomized controlled trial of standard vs endobronchial ul-trasonography-guided transbronchial needle aspiration in pa-tients with suspected sarcoidosis. Chest 2009;136(2):340-6.

Chee A, Khalil M, Stather DR, MacEachern P, Field SK, Tremblay A. Cytologic assessment of endobronchial ultrasound-guided transbronchial needle aspirates in sarcoidosis. J Bronchology Interv Pulmonol 2012; 19(1): 24−8.

Patelli M, Lazzari Agli L, Poletti V, Trisolini R, Cancellieri A, La-cava N,et al. Role of fiberscopic transbronchial needle aspira-tion in the staging of N2 disease due to non-small cell lung cancer. Ann Thorac Surg 2002; 73(2): 407−11.

Trisolini R, Lazzari Agli L, Cancellieri A, Poletti V, Tinelli C, Ba-ruzzi G, et al. The value of flexible transbronchial needle aspi-ration in the diagnosis of stage I sarcoidosis. Chest 2003; 124(6): 2126−30.

Cetinkaya E, Yildiz P, Kadakal F, Tekin A, Soysal F, Elibol S, et al. Transbronchial needle aspiration in the diagnosis of intra-thoracic lymphadenopathy. Respiration 2002; 69(4): 335−8.

Cetinkaya E, Yildiz P, Altin S, Yilmaz V. Diagnostic value of transbronchial needle aspiration by Wang 22-gauge cytology needle in intrathoracic lymphadenopathy. Chest 2004; 125(2): 527−31.

Smojver-Jezek S, Peros-Golubicić T, Tekavec-Trkanjec J, Mazuranić I, Alilović M. Transbronchial fine needle aspiration cytology in the diagnosis of mediastinal/hilar sarcoidosis. Cytopathology 2007; 18(1): 3−7.

Cancellieri A, Leslie KO, Tinelli C, Patelli M, Trisolini R. Sarcoidal granulomas in cytological specimens from intrathoracic ade-nopathy: Morphologic characteristics and radiographic correlations. Respiration 2013; 85(3): 244−51.

Asano S. Granulomatous lymphadenitis. J Clin Exp Hematopathol 2012; 52(1): 1−16.

Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997; 336: 1224−34.