Das Sumanta, Khan Adil Aziz, Jose Annmy
Department of Pathology, Fortis Memorial Research Institute, Gurugram, New Delhi, India.
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Rev Esp Patol. 2025 Jan-Mar;58(1):100798. doi: 10.1016/j.patol.2024.100798. Epub 2025 Jan 27.
Sarcoidosis, a granulomatous inflammatory disease, exhibits diverse clinical manifestations, often affecting multiple organs. Diagnostic challenges arise due to its similarities with tuberculosis, particularly in high-burden areas. Differentiating between the two relies on clinical judgment, laboratory tests, imaging, and invasive procedures. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a valuable diagnostic tool, enhancing both accuracy and patient care.
This study enrolled 279 suspected sarcoidosis cases, evaluated via EBUS-TBNA between November 2022 and August 2023. The inclusion criteria comprised intrathoracic lymphadenopathy on CT, with subsequent diagnoses of either sarcoidosis or tuberculosis. Clinical, radiological, and laboratory assessments, along with EBUS-TBNA, were conducted. Cytopathological analysis focused on the presence of granulomas, histiocytic clusters, lymphocyte depletion, and necrosis, which aided in diagnosis. Statistical analysis was conducted using SPSS software to evaluate sensitivity, specificity, and predictive values.
Out of 279 patients, 178 were diagnosed with sarcoidosis and 90 with tuberculosis. Adequate TBNA samples were obtained in 240 cases, predominantly from male patients. Negative tuberculin skin tests and negative culture studies were significant findings in the sarcoidosis cases (p<0.0001). Echotexture and necrosis were distinguishing features of tuberculosis, while granulomas and histiocyte patterns varied. The sensitivity and specificity for diagnosing sarcoidosis via cytomorphology were notable, particularly when combined with negative microbiological findings.
Cytomorphological analysis via EBUS-TBNA significantly aids in the diagnosis of sarcoidosis, despite overlapping features with tuberculosis. The absence of necrosis and distinctive granuloma characteristics contribute to its high sensitivity and specificity. Radiological correlations and microbiological findings further enhance diagnostic accuracy. This study underscores the importance of comprehensive evaluation in intrathoracic lymphadenopathies, highlighting the pivotal role of EBUS-TBNA in tuberculosis-endemic regions.
结节病是一种肉芽肿性炎症性疾病，临床表现多样，常累及多个器官。由于其与结核病相似，尤其是在高负担地区，诊断面临挑战。区分两者依赖于临床判断、实验室检查、影像学检查和侵入性操作。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）已成为一种有价值的诊断工具，提高了诊断准确性并改善了患者护理。
本研究纳入了2022年11月至2023年8月期间通过EBUS-TBNA评估的279例疑似结节病病例。纳入标准包括CT显示胸内淋巴结肿大，随后诊断为结节病或结核病。进行了临床、放射学和实验室评估以及EBUS-TBNA检查。细胞病理学分析重点关注肉芽肿、组织细胞簇、淋巴细胞耗竭和坏死的存在，这些有助于诊断。使用SPSS软件进行统计分析以评估敏感性、特异性和预测值。
279例患者中，178例诊断为结节病，90例诊断为结核病。在240例病例中获得了足够的TBNA样本，主要来自男性患者。结节病病例中结核菌素皮肤试验阴性和培养研究阴性是显著发现（p<0.0001）。回声纹理和坏死是结核病的特征，而肉芽肿和组织细胞模式有所不同。通过细胞形态学诊断结节病的敏感性和特异性显著，特别是与微生物学阴性结果相结合时。
尽管与结核病存在重叠特征，但通过EBUS-TBNA进行细胞形态学分析对结节病的诊断有显著帮助。无坏死和独特的肉芽肿特征使其具有高敏感性和特异性。放射学相关性和微生物学结果进一步提高了诊断准确性。本研究强调了对胸内淋巴结肿大进行综合评估的重要性，突出了EBUS-TBNA在结核病流行地区的关键作用。
