BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biop...BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.展开更多
基金Supported by the National Natural Science Foundation of China,No.82170103Natural Science Foundation of Fujian Province,No.2024J011325+1 种基金Young People Training Project from Fujian Province Health Bureau,No.2020GGB057 and No.2023QNB008Xiamen Medical and Health Guidance Project,No.3502Z20224ZD1060,No.3502Z20214ZD1043,and No.3502Z20224ZD1058.
文摘BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
