An 8 year- review of granulomatous inflammation in EBUS samples- common in sarcoidosis, rare but identified in the setting of cancer where FDG uptake can be observed on PET scanning.

We describe a cohort of patients who have evidence of granulomatous inflammation during EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration) done for the investigation of sarcoidosis and staging of a known lung cancer.Out of 800 EBUS performed between May 2010- Nov 2017, 500 yielded a benign diagnosis (men 55.6%). Rapid on-site evaluation by a cytopathologist was done in 82% of procedures and yielded a diagnosis in 86.8%.In the setting of suspected sarcoidosis (59.3%), the mean diagnostic yield was 61.05%, ATS Station 7 being the most commonly sampled lymph node (66.67%)Granulomatous inflammation was identified in 6.56%, who had a concurrent diagnosis of lung cancer, (6/31) and outside the lung (25/31), breast cancer was the most common cancer (10/25).Review of FDG PET CT scans of 7 of these 31 cases showed that the maximum standardised uptake value (SUVmax) in the lymph nodes was lower than the primary site in 6/7 (mean tumour SUV 12.12 [4-17.6] vs mean LN SUV 6.47 [2.3-37.5]) and the mean short axis diameter of the lymph nodes was 9.5mm [5-22mm].EBUS-TBNA remains the gold standard for the identification of granulomas in the investigation of sarcoidosis, but they can occasionally be identified in mediastinal and/or hilar lymphadenopathy in patients with concurrent malignancy, in particular breast cancer. PET scanning can show increased FDG uptake, emphasizing the importance of histologic confirmation of suspected lymph node involvement.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Lung Cancer Source Type: research