How are each of you utilizing the TBNA (Wang needle) in making the diagnosis of sarcoidosis? Stage I only? Stage II only? What sized TBNA needle are you using?
How many passes do you make with the needle (presuming you do not have cytology at the bedside?
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We use a 19 gauge needle and do about 3 passes in all sarcoid patients that have adenopathy, even stage III because we do not know the diagnosis yet or we wouldn't be doing the bronch, so a stage III may be some other ILD process with adenopathy. We also do endobronchial biopsies, trying to get down to submucosa, as this adds to yield. Some don't get it if there are no mucosal changes.
Stage III is ILD without adenopathy... where do you stick the needle?
meant stage 2...
I often also send the BAL for flow as well. A low CD4/CD8 ratio has a good negative PV for sarcoid and can help exclude it. Conversely, with the right clinical picture, a CD4 to CD8 ratio greater than 4:1 with a lymphocyte percentage greater than or equal to 16 percent, no Eos and no increase in PMNs can really help establish the Dx.
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