Endoscopic Ultrasonography with Fine-Needle Aspiration: An Accurate and Simple Diagnostic Modality for Sarcoidosis

Introduction

Endoscopic ultrasonography (EUS) is an established imaging technique that is now accepted as the most accurate method for locoregional tumor staging in gastrointestinal malignancies [1] [2] [3]. Until recently, computed tomography (CT) scanning was the primary method for imaging these neoplasms. There have been numerous reports showing that endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) is the most accurate nonsurgical method for detecting posterior mediastinal lymph nodes [4] [5]. Sarcoidosis is a chronic systemic disease that is characterized by noncaseating granulomas. The prevalence of sarcoidosis ranges from less than one case to 40 cases per 100 000, with an age-adjusted annual incidence rate in the United States of 10.9 per 100 000 for whites and 35.5 per 100 000 for blacks [6].

Its presentation varies from pulmonary involvement, with shortness of breath, to gastrointestinal involvement, with severe dysphagia [7] [8]. The diagnosis of sarcoidosis is often clinical, but it can also be corroborated by using laboratory tests such as angiotensin-converting enzyme (ACE) levels, or by histological confirmation using either transbronchial biopsy forceps or a Wang transbronchial needle via a fiberoptic bronchoscope [9].

Several large published series on EUS-FNA of mediastinal lymph nodes mention sarcoidosis as a diagnosis in their specimens [4] [5]. However, to our knowledge, no single paper has described the value of EUS with FNA for diagnosing sarcoidosis in detail. The present case series not only highlights the feasibility of EUS-directed FNA in the diagnosis of sarcoidosis, but also describes some salient endosonographic features suggestive of sarcoidosis.

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