effect of needle size in diagnostic yield of ebus-tbna in sarcoidosis and lymphoma

Conditions: Sarcoidosis; Lymphoma; Adenopathy Hilar

Summary: the guided fna by endobronchial ultrasound ( endobronchial ultrasound guided transbronchial needle aspiration or ebus-tbna) is a minimally invasive technique with an established role in the staging of lung cancer 1, and in the evaluation of intrathoracic lymph node metastases from extrathoracic primary cancer2 . there is also a role in cases of isolated hilar and mediastinal lymph nodes in which the differential diagnosis includes mostly sarcoidosis, lymphoma and tuberculosis. 3 various studies have evaluated more recently the diagnostic yield of ebus-tbna specifically for sarcoidosis 4 and thoracic lymphoma 5-6. although there is emerging data supporting the usefulness of ebus-tbna in the investigation of these two pathologies, the efficacy results vary according to the target populations and certain parameters. moreover, although a large randomized study demonstrated e superiority of ebus-tbna over conventional bronchoscopic sampling methods \[ bronchoalveolar lavage (bal) and trans-bronchial biopsies (tbb \] for the diagnosis of sarcoidosis , 7 the results suggest that there is still room for optimizing the performance of ebus-tbna \[b\] . in the field of lymphoma, obtaining large enough specimens for adequate subtyping also remains a concern. 8 in order to improve the performance of ebus -tbna , new needles have been developed with the aim to provide biopsies for histological evaluation rather than purely cytological. the vizishot flex © (olympus) 19 gauge needle (19 gauge or 19g) is a large needle, which can provide both tissue and needle aspiration , and has the advantage of being more flexible. for this study, the investigators want to compare the diagnostic yield of ebus-tbna using needle vizishot flex 19g (1.11 mm) with that of the standard 22g needle ( na-201sx; olympus) , in the investigation of hilar or mediastinal lymphadenopathy suspected to be sarcoidosis or lymphoma.


Eligibility criteria:
inclusion criteria * patient t referred for specimens by ebus -tbna with clinical and radiological suspicion of sarcoidosis or lymphoma , with pathological lymph node on imaging (small diameter ≥ 1.0 cm ct-scan or hyper metabolism with pet scan) in para-tracheal stations, sub-carinal and / or hilar (stations 2, 4, 7, 10, 11 and 12), right and / or left. * lymph nodes with a small diameter of at least 0.5 cm in ct-scan or pet / ct scan performed in the previous 4-6 weeks. * patient investigated in the setting of either an initial diagnosis or a suspicion of lymphoma recurrence (post-treatment). * patient able to consent to the procedure and to authorize us by written proxy, included in the consent form for the study, to obtain a copy of the subsequent results or radiological (pet, ct-scan, chest x-ray) or histopathological (linked with age sampled of intrathoracic lymph nodes). * patient deemed fit to tolerate the procedure. exclusion criteria * patient unable to give consent. * female patient during pregnancy * patient aged under 18. * patient with significant coagulopathy ( inr \> 1.5 ; platelet count\<50 000 / mm 3 ). * patient anticoagulated (oral or parenteral) and whose anticoagulation can not be suspended for the procedure. * obvious involvement of organ (s) with the possibility of confirming granulomas or suspicious cells of lymphoma by means of a procedure considered less invasive (.. e g, lymph node biopsy of cervical, supraclavicular or inguinal nodes; skin biopsy).

Keywords: sarcoidosis ebus endobronchial ultrasound