Comparison of endobronchial and transbronchial biopsies with high-resolution CT (HRCT) in the diagnosis of sarcoidosis

High-resolution computed tomography (HRCT) has been shown to accurately vis ualise parenchymal infiltrates of sarcoidosis. The aim of this study was to compare the diagnostic yield (DY) of HRCT with that of endobronchial (EBB) and transbronchial (TBB) biopsies in establishing the diagnosis of sarcoid osis. Forty-five patients referred to Helsinki University Central Hospital with a presumptive diagnosis of sarcoidosis underwent fiberoptic bronchosco py (FOB) with bronchoalveolar lavage (BAL), EBB, TBB and HRCT Thirty-seven of the patients were diagnosed as having sarcoidosis, 34 of whom showed a p arenchymal infiltrate in HRCT. One of the three patients with no parenchyma l findings, had positive findings in TBB, and all had lymphocytosis in BAL. The DY for sarcoidosis by EBB and TBB was 24.3% and 50.0%, respectively. T he addition of EBB to TBB improved the DY by 8.3%, whereas adding TBB to EB B improved the DY by 30.6%. There were no major complications after the FOE , which was always performed under fluoroscopic control. In conclusion, HRC T is a valuable tool in diagnosing sarcoidosis. However, the HRCT findings cannot be seen in all patients with positive findings in lung biopsy, nor i s the parenchymal infiltrate specific for sarcoidosis. Attempting biopsy-pr oven diagnosis of sarcoidosis is still recommended. Fiberoptic bronchoscopy with EBB and TBB under fluoroscopic control is a safe and well-tolerated p rocedure.