Original Articles
Clinical Utility of Transbronchial Needle Aspiration of Mediastinal Lymph Nodes in the Diagnosis of Sarcoidosis in Stages I and II
Alberto Fernández-Villara,
, María Isabel Botanaa, Virginia Leiroa, Cristina Represasa, Ana Gonzálezb, Mar Mosteiroa, Luis Piñeiroa
Corresponding author
Alberto.Fernandez.Villar@sergas.es
Correspondence: Dr. A. Fernández-Villar. Unidad de Broncoscopias. Servicio de Neumología. Hospital Xeral de Vigo. Pizarro, 22. 36204 Vigo. Pontevedra. España
Correspondence: Dr. A. Fernández-Villar. Unidad de Broncoscopias. Servicio de Neumología. Hospital Xeral de Vigo. Pizarro, 22. 36204 Vigo. Pontevedra. España
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Represas, Ana González, Mar Mosteiro, Luis Piñeiro" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Alberto" "apellidos" => "Fernández-Villar" "email" => array:1 [ 0 => "Alberto.Fernandez.Villar@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "María Isabel" "apellidos" => "Botana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Virginia" "apellidos" => "Leiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Cristina" "apellidos" => "Represas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Ana" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 5 => array:3 [ "nombre" => "Mar" "apellidos" => "Mosteiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 6 => array:3 [ "nombre" => "Luis" "apellidos" => "Piñeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Xeral de Vigo, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Xeral de Vigo, Complexo Hospitalario Universitario de Vigo, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. A. Fernández-Villar. Unidad de Broncoscopias. Servicio de Neumología. Hospital Xeral de Vigo. Pizarro, 22. 36204 Vigo. Pontevedra. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-10-03" "fechaAceptado" => "2007-01-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154998" "palabras" => array:5 [ 0 => "Sarcoidosis" 1 => "Bronchoscopy" 2 => "Transbronchial needle aspiration" 3 => "Transbronchial biopsy" 4 => "Bronchoalveolar lavage" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154997" "palabras" => array:5 [ 0 => "Sarcoidosis" 1 => "Broncoscopia" 2 => "Punción transbronquial" 3 => "Biopsia transbronquial" 4 => "Lavado broncoalveolar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar tanto la rentabilidad individual como La conjunta y la utilidad clínica de la punción transbronquial (PTB) y la biopsia transbronquial (BTB) en el diagnóstico histológico de sarcoidosis en estadios I y II.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio pros-pectivo en el que se incluyó a todos los pacientes con adenopatías mediastínicas de diámetro superior a 10 mm y sospecha clinicorradiológica de sarcoidosis, ingresados entre julio de 2001 y junio de 2006. Se realizó a todos, por este orden, PTB con agujas Bard-Wang 319 de una o más adenopatías hasta obtener un mínimo de 2 muestras satisfactorias; lava-do broncoalveolar, y 4-6 BTB.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyó en el estudio a 32 pacientes, de los que 26 presentaron un diagnóstico final de sarcoidosis. La edad media ± desviación estándar fue de 38,9 ± 10,6 años y 13 (50%) eran mujeres. El diámetro medio de las adenopatías fue de 23,5 ± 6,5 mm. Las estaciones ganglionares más puncionadas fueron la subcarinal, con 9 casos (37,7%), y la combinación subcarinal-paratraqueal derecha, con 7 (26,9%). Se observó afectación parenquimatosa en la tomografía computarizada de tórax en 12 (46,2%). La BTB fue diagnóstica en 15 pacientes (57,7%) y la PTB en 16 (61,5%), y fueron las únicas técnicas diagnósticas en 7 (26,9%) y 8 (30,8%) casos, respectivamente (p > 0,05). La combinación de ambas fue diagnóstica en 23 casos (88,4%), significativamente superior a la BTB (p = 0,01) y a la PTB (p = 0,02) por separado en todos los casos, y sólo a la BTB (p = 0,01) en los casos con afectación parenquimatosa. Únicamente 4 pacientes (15%) presentaron alguna complicación y en 20 (76,9%) la tolerancia fue buena.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La adición de la PTB a la BTB incrementa significativamente el número de diagnósticos de sarcoidosis, sobre todo en pacientes sin afectación parenquimatosa. El número de complicaciones es bajo y la tolerancia, buena.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "RP Baughman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2004.04.006" "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "521" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15331189" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 4 | 11 |
| 2024 October | 31 | 15 | 46 |
| 2024 September | 32 | 11 | 43 |
| 2024 August | 42 | 33 | 75 |
| 2024 July | 20 | 21 | 41 |
| 2024 June | 24 | 27 | 51 |
| 2024 May | 32 | 27 | 59 |
| 2024 April | 19 | 20 | 39 |
| 2024 March | 23 | 15 | 38 |
| 2024 February | 17 | 18 | 35 |
| 2023 March | 1 | 3 | 4 |
| 2023 February | 21 | 13 | 34 |
| 2023 January | 17 | 27 | 44 |
| 2022 December | 20 | 34 | 54 |
| 2022 November | 21 | 21 | 42 |
| 2022 October | 19 | 32 | 51 |
| 2022 September | 15 | 24 | 39 |
| 2022 August | 18 | 33 | 51 |
| 2022 July | 16 | 36 | 52 |
| 2022 June | 12 | 25 | 37 |
| 2022 May | 16 | 27 | 43 |
| 2022 April | 12 | 24 | 36 |
| 2022 March | 14 | 38 | 52 |
| 2022 February | 16 | 20 | 36 |
| 2022 January | 12 | 27 | 39 |
| 2021 December | 17 | 41 | 58 |
| 2021 November | 14 | 47 | 61 |
| 2021 October | 19 | 42 | 61 |
| 2021 September | 24 | 54 | 78 |
| 2021 August | 12 | 27 | 39 |
| 2021 July | 10 | 19 | 29 |
| 2021 June | 12 | 34 | 46 |
| 2021 May | 9 | 20 | 29 |
| 2021 April | 25 | 23 | 48 |
| 2021 March | 14 | 15 | 29 |
| 2021 February | 10 | 21 | 31 |
| 2021 January | 15 | 18 | 33 |
| 2020 December | 4 | 12 | 16 |
| 2020 November | 6 | 9 | 15 |
| 2020 October | 14 | 7 | 21 |
| 2020 September | 10 | 0 | 10 |
| 2020 August | 5 | 15 | 20 |
| 2020 July | 6 | 13 | 19 |
| 2020 June | 7 | 5 | 12 |
| 2020 May | 8 | 7 | 15 |
| 2020 April | 8 | 25 | 33 |
| 2020 March | 6 | 11 | 17 |
| 2020 February | 10 | 19 | 29 |
| 2020 January | 8 | 15 | 23 |
| 2019 December | 10 | 11 | 21 |
| 2019 November | 7 | 5 | 12 |
| 2019 October | 7 | 11 | 18 |
| 2019 September | 5 | 16 | 21 |
| 2019 August | 9 | 2 | 11 |
| 2019 July | 9 | 20 | 29 |
| 2019 June | 6 | 3 | 9 |
| 2019 May | 11 | 16 | 27 |
| 2019 April | 15 | 28 | 43 |
| 2019 March | 8 | 14 | 22 |
| 2019 February | 5 | 5 | 10 |
| 2019 January | 3 | 9 | 12 |
| 2018 December | 5 | 10 | 15 |
| 2018 November | 10 | 7 | 17 |
| 2018 October | 28 | 15 | 43 |
| 2018 September | 14 | 9 | 23 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 4 | 7 | 11 |
| 2018 March | 9 | 4 | 13 |
| 2018 February | 5 | 4 | 9 |
| 2018 January | 2 | 5 | 7 |
| 2017 December | 5 | 7 | 12 |
| 2017 November | 2 | 5 | 7 |
| 2017 October | 2 | 7 | 9 |
| 2017 September | 6 | 12 | 18 |
| 2017 August | 6 | 9 | 15 |
| 2017 July | 9 | 6 | 15 |
| 2017 June | 6 | 16 | 22 |
| 2017 May | 7 | 11 | 18 |
| 2017 April | 5 | 7 | 12 |
| 2017 March | 5 | 4 | 9 |
| 2017 February | 1 | 1 | 2 |
| 2017 January | 5 | 4 | 9 |
| 2016 December | 10 | 4 | 14 |
| 2016 November | 11 | 12 | 23 |
| 2016 October | 13 | 31 | 44 |
| 2016 September | 12 | 32 | 44 |
| 2016 August | 24 | 22 | 46 |
| 2016 July | 8 | 11 | 19 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 61 | 4 | 65 |
| 2015 September | 75 | 7 | 82 |
| 2015 August | 54 | 6 | 60 |
| 2015 July | 69 | 9 | 78 |
| 2015 June | 38 | 6 | 44 |
| 2015 May | 56 | 8 | 64 |
| 2015 April | 43 | 7 | 50 |
| 2015 March | 65 | 7 | 72 |
| 2015 February | 30 | 2 | 32 |
| 2015 January | 47 | 6 | 53 |
| 2014 December | 54 | 6 | 60 |
| 2014 November | 82 | 7 | 89 |
| 2014 October | 69 | 8 | 77 |
| 2014 September | 67 | 6 | 73 |
| 2014 August | 65 | 9 | 74 |
| 2014 July | 55 | 6 | 61 |
| 2014 June | 72 | 5 | 77 |
| 2014 May | 82 | 9 | 91 |
| 2014 April | 77 | 6 | 83 |
| 2014 March | 73 | 12 | 85 |
| 2014 February | 83 | 8 | 91 |
| 2014 January | 61 | 9 | 70 |
| 2013 December | 67 | 5 | 72 |
| 2013 November | 59 | 5 | 64 |
| 2013 October | 63 | 9 | 72 |
| 2013 September | 62 | 7 | 69 |
| 2013 August | 59 | 7 | 66 |
| 2013 July | 66 | 12 | 78 |
| 2013 June | 38 | 8 | 46 |
| 2013 May | 50 | 15 | 65 |
| 2013 April | 31 | 10 | 41 |
| 2013 March | 10 | 1 | 11 |
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