Clinical value of mediastinoscopy in the diagnosis of sarcoidosis: an analysis of 68 cases.

Mediastinoscopy was performed for confirmation of the diagnosis in 68 patients who were suspected clinically and radiologically of having sarcoidosis. In 66 of 68 cases in which mediastioscopy was performed a diagnosis was attained. In 35 cases, endobronchial biopsy was performed by bronchoscopy. In only 5 of these (14.2 %) was the diagnosis of sarcoidosis confirmed. The sensitivity of mediastinoscopy was remarkably superior compared with that of endobronchial biopsy. No complication developed with either mediastinoscopy or endobronchial biopsy. In Turkey, mediastinoscopy without any complication costs about 650 USD while bronchoscopy and endobronchial biopsy cost about 150 USD. In our study in which we looked for a histological confirmation -- in the cases suspected of sarcoidosis -- mainly through mediastinoscopy and rarely through other methods (i.e., endobronchial biopsy in one case, skin biopsy in another), we did not come up with a different diagnosis. Therefore, patients suspected of having sarcoidosis should undergo a careful clinical, laboratory, and radiologic examination; they should be under continuous close observation; when necessary (e.g., skin and lip biopsy), the tissue diagnosis should be made by other methods, but if there is the possibility of a disease such as tuberculosis and lymphoma, mediastinoscopy should be performed. The diagnosis of stage 3 sarcoidosis is difficult. For diagnosis, sometimes videothoracoscopy or explorative thoracotomy may be necessary. However, in all our 3 cases with stage 3, we reached the diagnosis of sarcoidosis by the less invasive and less expensive method of mediastinoscopy. Despite our small number of cases, we believe that mediastinoscopy is a very important instrument for diagnosis of stage 3 sarcoidosis.