The clinical application and cost analysis of fine-needle aspiration biopsy in the diagnosis of mass lesions in sarcoidosis

Background: Sarcoidosis is a prevalent disease of unknown cause characteriz ed by granulomatous inflammation that often creates deep and/or superficial mass lesions. Tissue samples ale considered the "gold standard" ill diagno sis; however, it is a medically treated disease. We analyzed the utility an d relative cost-effectiveness of fine-needle aspiration biopsy (FNAB) in th e clinical investigation of patients with both suspected and unsuspected sa rcoidosis. Methods: All FNAB cases with sarcoidosis either as the cytologic diagnosis or mentioned as part of the differential diagnosis were retrospectively rev iewed for clinical history, follow-up, cytologic features, and surgical pat hology findings. Comparative anal? sis of cost of FNAB and excisional biops y were also made. Results: Thirty-two FNABs in 28 patients included 17 women and 11 men, Anat omic sites included lymph node (n = 17), lung (n = 5), salivary gland (n = 8), and liver (n = 2), Sarcoidosis had already been diagnosed or was a clin ical consideration prior to FNAB ill 14 cases. Chest radiograph showed abno rmal findings in 19 cases. Angiotensin-converting enzyme (ACE) wits measure d in seven patients and was elevated in four. All aspirates showed granulom atous inflammation; in 22 patients, special stains or cultures for microorg anisms n ere negative, Simultaneous or subsequent excisional biopsies confi rmed the FNAB findings in 17 patients. Institutional ratios of excisional b iopsy to FNAB in the diagnosis of sarcoidosis ranged from 4 to 19:1, The co st of FNAB was only 12.5 to 50% that of tissue biopsy, Conclusions: FNAB appears to be underutilized in the diagnosis of sarcoidos is. When used in conjunction with radiologic and laboratory data, FNAB may be a reliable and cost-effective method of diagnosis, especially in patient s with an established diagnosis of sarcoidosis.