Background: Several studies have reported that specimens from mediastinal lesions located adjacent to the esophagus can be sampled using an ultrasound bronchoscope instead of an ultrasound endoscope. Objectives: The aim of this study was to evaluate the diagnostic utility of transesophageal bronchoscopic ultrasound-guided fine needle aspiration using an ultrasound bronchoscope in patients with stage I/II sarcoidosis. Methods: Thirty-three patients suspected of having stage I/II sarcoidosis were included in this prospective study. Needle aspiration through the esophagus using an ultrasound bronchoscope was performed for hilar and/or mediastinal lymph nodes. The final diagnosis of sarcoidosis was based on clinicoradiological compatibility and pathological findings. Results: A total of 62 lymph nodes with a mean shortest diameter of 13.6 mm were examined. Of the 33 patients enrolled, 29 were given a final diagnosis of sarcoidosis. Four of the residual patients had other diseases (1 lung cancer, 1 tuberculosis, 2 non-specific lymphadenitis). Transesophageal bronchoscopic ultrasound-guided fine needle aspiration showed noncaseating epithelioid cell granulomas in 25 of 29 patients (86%; 95% confidence interval 73–100) with the final diagnosis of sarcoidosis. No complications were observed. Conclusions: Transesophageal bronchoscopic ultrasound-guided fine needle aspiration is feasible, safe and accurate for the diagnosis of stage I/II sarcoidosis.

1.
Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999;160:736–755.
2.
Nakajima T, Yasufuku K, Kurosu K, Takiguchi Y, Fujiwara T, Chiyo M, Shibuya K, Hiroshima K, Nakatani Y, Yoshino I: The role of EBUS-TBNA for the diagnosis of sarcoidosis: comparisons with other bronchoscopic diagnostic modalities. Respir Med 2009;103:1796–1800.
3.
de Boer S, Milne DG, Zeng I, Wilsher ML: Does CT scanning predict the likelihood of a positive transbronchial biopsy in sarcoidosis? Thorax 2009;64:436–439.
4.
Navani N, Booth HL, Kocjan G, Falzon M, Capitanio A, Brown JM, Porter JC, Janes SM: Combination of endobronchial ultrasound guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis. Respirology 2011;16:467–472.
5.
Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Ichihara S, Moritani S: Prospective study of endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes versus transbronchial lung biopsy of lung tissue for diagnosis of sarcoidosis. J Thorac Cardiovasc Surg 2012;143:1324–1329.
6.
Herth FJ, Rabe KF, Gasparini S, Annema JT: Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions. Eur Respir J 2006;28:1264–1275.
7.
Varela-Lema L, Fernández-Villar A, Ruano-Ravina A: Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J 2009;33:1156–1164.
8.
Fritscher-Ravens A, Sriram PV, Topalidis T, Hauber HP, Meyer A, Soehendra N, Pforte A: Diagnosing sarcoidosis using endosonography-guided fine-needle aspiration. Chest 2000;118:928–935.
9.
Annema JT, Veseliç M, Rabe KF: Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Eur Respir J 2005;25:405–409.
10.
Iwashita T, Yasuda I, Doi S, Kato T, Sano K, Yasuda S, Nakashima M, Hirose Y, Takaimi T, Moriwaki H: The yield of endoscopic ultrasound-guided fine needle aspiration for histological diagnosis in patients suspected of stage I sarcoidosis. Endoscopy 2008;40:400–405.
11.
von Bartheld MB, Veseliç-Charvat M, Rabe KF, Annema JT: Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Endoscopy 2010;42:213–217.
12.
Tournoy KG, Bolly A, Aerts JG, Pierard P, De Pauw R, Leduc D, Leloup A, Pieters T, Slabbynck H, Janssens A, Carron K, Schrevens L, Pat K, De Keukeleire T, Dooms C: The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis. Eur Respir J 2010;35:1329–1335.
13.
Wong M, Yasufuku K, Nakajima T, Herth FJ, Sekine Y, Shibuya K, Iizasa T, Hiroshima K, Lam WK, Fujisawa T: Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis. Eur Respir J 2007;29:1182–1186.
14.
Oki M, Saka H, Kitagawa C, Tanaka S, Shimokata T, Kawata Y, Mori K, Kajikawa S, Ichihara S, Moritani S: Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology 2007;12:863–868.
15.
Garwood S, Judson MA, Silvestri G, Hoda R, Fraig M, Doelken P: Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis. Chest 2007;132:1298–1304.
16.
Tremblay A, Stather DR, Maceachern P, Khalil M, Field SK: A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest 2009;136:340–346.
17.
Hwangbo B, Lee HS, Lee GK, Lim KY, Lee SH, Kim HY, Lee JY, Zo JI: Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope. Respirology 2009;14:843–849.
18.
Oki M, Saka H, Kitagawa C, Sato S: Bronchoscopic transesophageal ultrasound-guided needle aspiration: an alternative to the conventional transesophageal ultrasound-guided needle aspiration technique. J Thorac Cardiovasc Surg 2010;139:1659–1661.
19.
Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, Lee HS, Kim MS, Lee JM, Nam BH, Zo JI: Transbronchial and transesophageal fine needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 2010;138:795–802.
20.
Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A: Combined endoesophageal-endobronchial ultrasound-guided, fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest 2010;138:790–794.
21.
Medford AR, Agrawal S: Single bronchoscope combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration for tuberculous mediastinal nodes. Chest 2010;138:1274.
22.
Oki M, Saka H, Kitagawa C: Transesophageal bronchoscopic ultrasound-guided fine-needle aspiration for diagnosis of peripheral lung cancer. Ann Thorac Surg 2011;91:1613–1616.
23.
Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Ichihara S, Moritani S, Ando M: Randomized study of 21-gauge versus 22-gauge endobronchial ultrasound-guided transbronchial needle aspiration needles for sampling histology specimens. J Bronchol Inter Pulmonol 2011;18:306–310.
24.
Mountain CF, Dresler CM: Regional lymph node classification for lung cancer staging. Chest 1997;111:1718–1723.
25.
British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standards of Care Committee of British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 2001;56(suppl 1):i1–i21.
26.
Tambouret R, Geisinger KR, Powers CN, Khurana KK, Silverman JF, Bardales R, Pitman MB: The clinical application and cost analysis of fine-needle aspiration biopsy in the diagnosis of mass lesions in sarcoidosis. Chest 2000;117:1004–1011.
27.
Vilmann P, Jacobsen GK, Henriksen FW, Hancke S: Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992;38:172–173.
28.
Annema JT, Rabe KF: Why respiratory physicians should learn and implement EUS-FNA. Am J Respir Crit Care Med 2007;176:99.
29.
Cetinkaya E, Yılmaz A, Ozgul A, Gencoglu A, Gunluoglu G: Left atrial mass demonstrated during endobronchial ultrasound session. Respiration 2011;81:57–58.
30.
Annema JT, Rabe KF: Endosonography for lung cancer staging: one scope fits all? Chest 2010;138:765–767.
31.
Wang KP, Feller-Kopman D, Mehta A, Sharma M, Yarmus L: Endobronchial ultrasound and esophageal ultrasound: just because we can, does not necessarily mean we should. Chest 2011;140:271–272.
32.
Jones AM, O’Driscoll R: Do all patients require supplemental oxygen during flexible bronchoscopy? Chest 2000;119:1906–1909.
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