Diagnostic Modalities in Sarcoidosis: BAL, EBUS, and PET

Ulrich Costabel; Francesco Bonella; Shinichiro Ohshimo; Josune Guzman

doi:10.1055/s-0030-1262207

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2010; 31(4): 404-408
DOI: 10.1055/s-0030-1262207

Diagnostic Modalities in Sarcoidosis: BAL, EBUS, and PET

Ulrich Costabel¹ , Francesco Bonella¹ , Shinichiro Ohshimo¹ , Josune Guzman²

¹Medical Faculty, University of Duisburg-Essen, Department of Pneumology/Allergy, Ruhrlandklinik, Essen, Germany
²General and Experimental Pathology, Ruhr-University, Bochum, Germany

Abstract

ABSTRACT

Advances have been made in minimally invasive diagnostic procedures in sarcoidosis, including bronchoalveolar lavage (BAL), endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA), and positron emission tomography (PET). Several independent groups found almost identical predictive values of the CD4:CD8 ratio in BAL for the diagnosis of sarcoidosis. A CD4:CD8 ratio greater than 3.5 shows a high specificity of 93 to 96% for sarcoidosis, but the sensitivity is low (53 to 59%). EBUS-TBNA is a safe and useful tool for diagnosing sarcoidosis stage I and II with a sensitivity of 83 to 93% and a specificity of 100%. Novel imaging techniques have been explored, such as PET using L-[3-¹⁸F] fluoro-α–methyltyrosine (¹⁸F-F MT), which is more specific for malignancy than ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG)-PET. The combined modality of FMT-PET with FDG-PET could successfully discriminate sarcoidosis from malignancy. These recent developments including novel biopsy procedures and novel imaging techniques could be of value to diagnosing sarcoidosis.

KEYWORDS

Bronchoalveolar lavage (BAL) - endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) - positron emission tomography (PET) - sarcoidosis - diagnosis

Full Text

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Ulrich CostabelM.D.

Ruhrlandklinik, Tueschener Weg 40

D-45239 Essen, Germany

Email: ulrich.costabel@ruhrlandklinik.uk-essen.de