EUS—A Forgotten Tool for Diagnosing Sarcoidosis

Background: Sarcoidosis is a systemic granulomatous disease, with a predilection for the lung and mediastinal lymph nodes. However, the systemic nature of the disease can lead to diverse manifestations, such as isolated retroperitoneal lymphadenopathy (LN) or intra-abdominal organ involvement. Diagnosis of sarcoidosis is not standardized, but is based on three major criteria: a compatible clinical presentation, the finding of nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. In this study we present the data regarding the role and utility of EUS FNB in patients with suspected sarcoidosis with lymphadenopathy.

Aim: To study the diagnostic yield of EUS-guided FNB in diagnosing sarcoidosis with predominant lymphadenopathy.

Methods: This is a retrospective study, in this EUS databases were analyzed at a tertiary care center—Believers Church Medical College Hospital from January 2019 to October 2023. Patients of all age groups with clinical suspicion of sarcoidosis and lymphadenopathy on CT thorax and CT abdomen were included in this study, all these patients’ diagnoses were not established by other means. Patients with severe coagulopathy, inaccessible Lymph nodes on EUS and previously diagnosed patients were excluded from the study

Diagnosis on EUS-FNB was made on cytology and histology by expert pathologists. Final diagnosis was based on combined clinical presentation, EUS-FNB result, and clinicoradiological response to treatment at follow-up of 6 months.

Figure 1

Results: A total of 25 patients who underwent EUS FNB were included in the study. Six patients were males and 19 patients were females. The median age was 57 (35–86). The most common site of biopsy was subcarinal lymph node, followed by periportal lymph nodes. In biopsy, sarcoidosis was proven in 20 patients (80%), tuberculosis was diagnosed in 3 (12%), while biopsy was not diagnostic in 2 cases (8%).

Conclusion: EUS is an invaluable, yet under-utilized tool in diagnosing sarcoidosis. Most mediastinal lymph nodes (except pre-vascular and lung hilar), both lobes of liver and upper intra-abdominal lymph nodes can be sampled by EUS. EUS being a relatively noninvasive modality compared to mediastinoscopy or laparoscopy should be a front-line investigation for diagnosis in suspected sarcoidosis cases.

Publication History

Article published online:
22 April 2024