Endosonography vs Conventional Bronchoscopy for the Diagnosis of Sarcoidosis The GRANULOMA Randomized Clinical Trial

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art_MAUAD_Endosonography_vs_Conventional_Bronchoscopy_for_the_Diagnosis_of_2013.PDF (289.03 KB)
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193
Tipo de produção
article
Data de publicação
2013
Editora
AMER MEDICAL ASSOC
DOI
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Scopus
Web of Science
PubMed
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Título do Volume
Autores
BARTHELD, Martin B. von
DEKKERS, Olaf M.
SZLUBOWSKI, Artur
EBERHARDT, Ralf
HERTH, Felix J.
VEEN, Johannes C. C. M. in't
JONG, Ynze P. de
HEIJDEN, Erik H. F. M. van der
TOURNOY, Kurt G.
CLAUSSEN, Martin
Autor de Grupo de pesquisa
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Citação
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, v.309, n.23, p.2457-2464, 2013
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Resumo
Importance Tissue verification of noncaseating granulomas is recommended for the diagnosis of sarcoidosis. Bronchoscopy with transbronchial lung biopsies, the current diagnostic standard, has moderate sensitivity in assessing granulomas. Endosonography with intrathoracic nodal aspiration appears to be a promising diagnostic technique. Objective To evaluate the diagnostic yield of bronchoscopy vs endosonography in the diagnosis of stage I/II sarcoidosis. Design, Setting, and Patients Randomized clinical multicenter trial (14 centers in 6 countries) between March 2009 and November 2011 of 304 consecutive patients with suspected pulmonary sarcoidosis (stage I/II) in whom tissue confirmation of noncaseating granulomas was indicated. Interventions Either bronchoscopy with transbronchial and endobronchial lung biopsies or endosonography (esophageal or endobronchial ultrasonography) with aspiration of intrathoracic lymph nodes. All patients also underwent bronchoalveolar lavage. Main Outcomes and Measures The primary outcome was the diagnostic yield for detecting noncaseating granulomas in patients with a final diagnosis of sarcoidosis. The diagnosis was based on final clinical judgment by the treating physician, according to all available information (including findings from initial bronchoscopy or endosonography). Secondary outcomes were the complication rate in both groups and sensitivity and specificity of bronchoalveolar lavage in the diagnosis of sarcoidosis. Results A total of 149 patients were randomized to bronchoscopy and 155 to endosonography. Significantly more granulomas were detected at endosonography vs bronchoscopy (114 vs 72 patients; 74% vs 48%; P < .001). Diagnostic yield to detect granulomas for endosonography was 80%(95% CI, 73%-86%); for bronchoscopy, 53%(95% CI, 45%-61%) (P < .001). Two serious adverse events occurred in the bronchoscopy group and 1 in the endosonography group; all patients recovered completely. Sensitivity of the bronchoalveolar lavage for sarcoidosis based on CD4/CD8 ratio was54%(95% CI, 46%-62%) for flow cytometry and 24% (95% CI, 16%-34%) for cytospin analysis. Conclusion and Relevance Among patients with suspected stage I/II pulmonary sarcoidosis undergoing tissue confirmation, the use of endosonographic nodal aspiration compared with bronchoscopic biopsy resulted in greater diagnostic yield.
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https://observatorio.fm.usp.br/handle/OPI/2194
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/05