Endoscopic ultrasonography with fine-needle aspiration: An accurate and simple diagnostic modality for sarcoidosis

Background and Study Aims: Sarcoidosis is a chronic multisystem granulomato us disease that is often diagnosed after a finding of hilar and mediastinal lymphadenopathy on a chest radiograph. This often requires further evaluat ion by transbronchial biopsy or other clinical parameters. The present stud y is a descriptive, retrospective one using endoscopic ultrasound with fine -needle aspiration (EUS-FNA) of mediastinal lymph nodes in seven patients w ith sarcoidosis. Patients and Methods: Among 108 consecutive patients who underwent EUS-FNA of mediastinal lymph nodes for various clinical indications between July 19 94 and October 1997, seven patients were found to have sarcoidosis on EUS-F NA, and the EUS morphology was studied in these patients. Results: Sarcoidosis was diagnosed in seven patients using endosonographic characteristics and clinical follow-up. EUS with FNA showed cytological evi dence of sarcoidosis in six patients. Seven patients were found to have sub carinal lymph nodes, and six patients had abnormally enlarged aortopulmonar y (AP) window lymph nodes. The nodes in all patients had three endosonograp hic criteria for malignancy. The long axis of the largest mediastinal lymph nodes measured 3.44 +/- 1.42 cm (range 1.8-6.0 cm). The short axis measure d 2.50 +/- 0.69 (range 1.0-4.0 cm). The average number of nodes seen in eac h patient was 2.80 +/- 0.75 (range 2-4). The nodes in all seven patients we re discrete and well demarcated. A central hyperechoic strand was evident i n these nodes in four patients (57 %). There were no complications. Conclusions: Mediastinal lymph nodes in patients with sarcoidosis appear to have specific echo characteristics, and EUS-FNA can be used for confirmato ry tissue diagnosis.