Advancements in pulmonary endosonography : the new standard to diagnose sarcoidosis and assessment of its safety profile

Bartheld, M.B. von (2016)

Doctoral Thesis

This thesis has dealt with the role of endosonography in the diagnosis
of sarcoidosis.
The main conclusion is that endosonography with aspiration of mediastinal lymph nodes has
superior diagnostic yield in comparison to conventional bronchoscopy with taking of peripheral
(TBLB) and endobronchial (EBB) tissue (80% vs 53%). Guidelines advising to perform
bronchoscopy (including TBLB and EBB) as a first choice procedure to detect granulomas
should be revised. In case EUS or EBUS are not available, bronchoscopy may reach comparable
sensitivity but only if cTBNA, TBLB and EBB are all performed. This will increase procedure
time and likely also complications because of the number of needle and forceps samples. Secondly, we assessed morbidity and mortality rates of EBUS and EUS for pulmonary indications
and found that both techniques are very safe. Fatalities have been described but are very
rare with a mortality rate of 0.04% and mostly occurred in patients of fragile health. Serious
adverse events happen occasionally (0.15%) and are mostly of infectious origin in patients
undergoing needle aspiration of cysts, sarcoid of necrotic lymph nodes.

 

• EUS
• EBUS
• FNA
• TBNA
• Sarcoïdosis
• Complications
• Safety
• Mediastinitis
• Bronchoscopy

• All authors: Bartheld, M.B. von
• Supervisor: Annema, J.T.; Rabe, K.F.G.
• Committee: Drent, M.; Grutters, J.C.; Smit, V.T.H.B.M.; Taube, C.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2016-12-06
• ISBN (print): 9789461699718