EBUS versus EUS-B for diagnosing sarcoidosis: The International Sarcoidosis Assessment (ISA) randomized clinical trial.

BACKGROUND AND OBJECTIVE: Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head-to-head comparison of both routes has never been performed. METHODS: Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)-B-guided nodal sampling, and to 22- or 25-G ProCore needle aspiration (2 × 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow-up at 6 months. RESULTS: A total of 358 patients were randomized: 185 patients to EBUS-transbronchial needle aspiration (EBUS-TBNA) and 173 to EUS-B-fine-needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63-76) for EBUS-TBNA and 68% (118/173; 95% CI, 61-75) for EUS-B-FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71-84) for EBUS-TBNA and 82% (115/141; 95% CI, 74-87) for EUS-B-FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity. CONCLUSION: Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS-B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients.

A syringe simulation of biological controls for quality assessment of prospective lung volume measurements.

BACKGROUND: At present a syringe is being used for calibration of lung function devices, but biological controls are used to detect prospectively the variability and reproducibility of lung volumes measured by spirometers. Laboratory personnel is often used as biological control and therefore the cost for these measurements is substantial and may be reduced by replacement of a syringe procedure to increase the capacity of the laboratory to measure more patients. OBJECTIVES: To develop a mechanical syringe procedure for identification of instrument problems. METHODS: A commercial 3-liter precision syringe is used to simulate breathing maneuvers (inspiratory vital capacity, functional residual capacity, residual volume and total lung capacity) on a spirometer. Three healthy males representing biological controls performed spirometry, maximum expiratory flow volume and helium dilution forced residual capacity at bimonthly intervals for 3 years. Confidence intervals and interval widths are calculated for each parameter. Levene's test for equality of variances was used to test for significance between standard deviations. RESULTS: The interval width of inspiratory vital capacity, functional residual capacity, total lung capacity and residual volume of repeated measurements obtained from the syringe was significantly narrower than those of biological controls. In addition, almost all standard deviations from lung volumes obtained from the syringe were smaller and significantly different from those of the biological control. CONCLUSION: Our syringe procedure may replace biological controls for detection of variability of lung volumes. This will result in cost reduction and improve quality assessment of lung function devices.