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

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Abstract
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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