Chest
Volume 111, Issue 3, March 1997, Pages 619-622
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Clinical Investigations: Sarcoidosis
Endobronchial Disease and Racial Differences in Pulmonary Sarcoidosis

https://doi.org/10.1378/chest.111.3.619Get rights and content

In a retrospective review of 7 years of Walter Reed Army Medical Center fiberoptic bronchoscopy records, 154 patients with biopsy specimen proved (122) and clinically diagnosed (32) sarcoidosis were identified. Endobronchial mucosal appearance was normal in only 70 (45%). Abnormal mucosal findings included erythema (29 patients), nodules (13), plaques (13), and cobblestoning (29). Fifty-nine patients were evaluated with endobronchial biopsies (EBBX), and non-necrotizing granulomata diagnostic of sarcoidosis were found in 42 (71%). The diagnostic yield from endobronchial biopsies was similar regardless of the type of mucosal abnormality. EBBX specimens were diagnostic in 85% of black patients and 38% of white patients (p=0.00081), but diagnostic yield did not correlate with patient's sex, symptoms, radiographic stage of disease, or extent of physiologic abnormalities. Four patients with normal-appearing bronchial mucosa underwent EBBX, and sarcoidosis was diagnosed in two. Transbronchial lung biopsy (TBBX) specimens were diagnostic of sarcoidosis in 61 of 82 (74%) black and 28 of 56 (50%) white patients (p=0.0038). We conclude that the bronchial mucosa appears abnormal in the majority (55%) of patients with sarcoidosis. EBBX specimens will diagnose sarcoidosis in a high percentage of such patients and should be performed routinely. EBBX may be preferable to TBBX because of its greater safety profile. In our patients, the yield of both EBBX and TBBX was significantly greater in African-Americans than white Americans.

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MATERIALS AND METHODS

We examined the FB records from January 1988 to December 1994, which are maintained by the Pulmonary and Critical Care Medicine Service at Walter Reed Army Medical Center. Our institution is a tertiary care, referral center, which cares for both active duty military personnel and their family members from the northeastern United States and Europe and for military retirees and their spouses. The active-duty population is composed of young adults from a variety of ethnic backgrounds. Our

RESULTS

Records of 3,186 FBs performed between 1988 and 1994 were retrospectively reviewed. Charts for 202 patients with suspected sarcoidosis were further examined and 48 were eliminated because other benign or malignant diagnoses were made. This left 154 patients, of whom 122 (79.9%) had the diagnosis of sarcoidosis confirmed by tissue biopsy specimen and 32 (20.1%) whose conditions were diagnosed clinically. Patients' ages ranged from 17 to 73 years (mean±SD, 35.8 ± 0.77). There were 48 black women,

DISCUSSION

Since 1975, pulmonary physicians have utilized the FB to diagnose intrathoracic sarcoidosis.3,4,8, 9, 10, 11 After initial reports revealed a high diagnostic yield of TBBX, especially in patients with parenchymal involvement, the method of performing TBBX rapidly evolved and diagnostic efforts were focused on lung tissue. Various authors used statistical analysis to predict the number of TBBXs needed to make this diagnosis reliably.9, 10, 11

Additional diagnostic methods have been described in

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Endobronchial sarcoidosis data presented at Chest 1995, October 29-Nov 2, 1995, New York, and published in CHEST; racial differences data presented at the 1996 American Thoracic Society Meeting, May 12–15, and published in Am J Respir Crit Care Med.

The findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents.

No financial support related to this manuscript was received by any of its authors.

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