TY - JOUR
T1 - EBUS versus EUS-B for diagnosing sarcoidosis
T2 - The International Sarcoidosis Assessment (ISA) randomized clinical trial
AU - Crombag, Laurence M. M.
AU - Mooij-Kalverda, Kirsten
AU - Szlubowski, Artur
AU - Gnass, Maciej
AU - Tournoy, Kurt G.
AU - Sun, Jiayuan
AU - Oki, Masahide
AU - Ninaber, Maarten K.
AU - Steinfort, Daniel P.
AU - Jennings, Barton R.
AU - Liberman, Moishe
AU - Bilaceroglu, Semra
AU - Bonta, Peter I.
AU - Korevaar, Daniël A.
AU - Trisolini, Rocco
AU - Annema, Jouke T.
N1 - Publisher Copyright: © 2021 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.
PY - 2021
Y1 - 2021
N2 - Background and objective: Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head-to-head comparison of both routes has never been performed. Methods: Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)-B-guided nodal sampling, and to 22- or 25-G ProCore needle aspiration (2 × 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow-up at 6 months. Results: A total of 358 patients were randomized: 185 patients to EBUS-transbronchial needle aspiration (EBUS-TBNA) and 173 to EUS-B-fine-needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63–76) for EBUS-TBNA and 68% (118/173; 95% CI, 61–75) for EUS-B-FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71–84) for EBUS-TBNA and 82% (115/141; 95% CI, 74–87) for EUS-B-FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity. Conclusion: Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS-B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients.
AB - Background and objective: Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head-to-head comparison of both routes has never been performed. Methods: Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)-B-guided nodal sampling, and to 22- or 25-G ProCore needle aspiration (2 × 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow-up at 6 months. Results: A total of 358 patients were randomized: 185 patients to EBUS-transbronchial needle aspiration (EBUS-TBNA) and 173 to EUS-B-fine-needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63–76) for EBUS-TBNA and 68% (118/173; 95% CI, 61–75) for EUS-B-FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71–84) for EBUS-TBNA and 82% (115/141; 95% CI, 74–87) for EUS-B-FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity. Conclusion: Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS-B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients.
KW - EBUS
KW - EUS-B
KW - bronchoscopy and interventional techniques
KW - diagnostic accuracy
KW - endoscopic ultrasound using the EBUS scope
KW - endosonography
KW - sarcoidosis
UR - http://www.scopus.com/inward/record.url?scp=85119108992&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/resp.14182
DO - https://doi.org/10.1111/resp.14182
M3 - Article
C2 - 34792268
SN - 1323-7799
JO - Respirology (Carlton, Vic.)
JF - Respirology (Carlton, Vic.)
ER -