BRONCHOSCOPIC DIAGNOSIS OF SARCOIDOSIS

Transbronchial lung biopsy (TBLB), transbronchial needle aspiration (T BNA) of mediastinal lymph nodes and bronchoalveolar lavage (BAL) are r outinely performed at fibreoptic bronchoscopy. Up to the present time, no data have been available on the efficacy of performing all three o f these procedures simultaneously in the bronchoscopic work-up of sarc oidosis. A prospective study was undertaken to compare the diagnostic yield from TBLB, TBNA and BAL in patients presenting with clinical and radiological features typical of sarcoidosis. Thirteen consecutive pa tients with clinical and radiological features consistent with stage I and II sarcoidosis underwent bronchoscopy with TBLB, TBNA and BAL. No ncaseating granulomata (stain and culture negative for tuberculosis ba cilli and fungi) were found in seven of the 13 patients by TBLB, and i n sis of the 13 patients hv TBNA (of which four patients had negative TBLB), Eight of the 13 patients had classical ''sarcoid'' BAL findings , i.e. >12% lymphocytes, and high CD4+:CD8+ lymphocyte ratio, Combinin g TBLB, TBNA and BAL gave a diagnostic sensitivity of 100% (12 out of 12 patients) for sarcoidosis. The remaining patient had nondiagnostic bronchoscopic studies and mediastinoscopy biopsy showed a non-Hodgkin' s lymphoma, Our data suggest that performing simultaneous transbronchi al lung biopsy, transbronchial needle aspiration and bronchoalveolar l avage produces optimal results in the diagnosis of sarcoidosis.