The Wang transbronchial needle in sarcoidosis: An Irish experience

PURPOSE: The standard practice in Ireland for obtaining a tissue diagnosis of sarcoidosis is a transbronchial forceps biopsy (TBBx) taken through the fibreoptic bronchoscope (FOB). This method carries an appreciable risk of pneumothorax and haemorrhage and only achieves a diagnosis in 70% of cases. The remaining 30% would require a more invasive procedsure such as mediastinoscopy or open lung biopsy. We investigated the suitability of a Wang transbronchial needle (MW-319, Millrose Laboratories), developed in the 1980's for use through the FOB, as a means of obtaining mediastinal lymph node tissue to establish a diagnosis of sarcoidosis. METHODS: We prospectively studied 10 patients with clinical and radiographic findings consistent with sarcoidosis. All 10 patients underwent bronchoscopy with TBBx and transbronchial needle aspiration biopsies (TBNA) from mediastinal lymph nodes. RESULTS: Of the 10 patients 4 had negative TBBx (i.e. no diagnostic granulomas seen) and of these 4 patients 3 were diagnosed using TBNA. The remaining patient had negative TBBx and TBNA and underwent a mediastinoscopic biopsy which showed Hodgkin's lymphoma. No patients had complications from TBNA. CONCLUSIONS: This is the first series of sarcoid patients in Ireland who have had Wang needle biopsy of their mediastinal lymph nodes. Our diagnostic yield was 30% but these patients avoided a more invasive diagnostic procedure because of successful TBNA. CLINICAL IMPLICATIONS: We conclude that TBNA is a safe technique and that it has a role in the diagnosis of sarcoidosis where TBBx is negative and the physician wishes to avoid a more invasive procedure such as mediastinoscopy or open lung biopsy.