# Bronchoscopic Diagnosis of Pulmonary Sarcoidosis Using Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration (EBUS-TBNA) and Transbronchial Lung Cryobiopsy (TBLC): A Safe and High-Yield Dual Approach

## TL;DR

Combining EBUS-TBNA and TBLC improves diagnosis of pulmonary sarcoidosis safely and effectively.

## Contribution

Demonstrates that combining EBUS-TBNA and TBLC achieves higher diagnostic yield than either method alone.

## Key findings

- Combined EBUS-TBNA and TBLC achieved 100% diagnostic yield.
- TBLC did not increase procedure time or complications significantly.
- Diagnostic yield was higher with more biopsy samples and specific CT patterns.

## Abstract

Background: Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA) and transbronchial lung cryobiopsy (TBLC) are widely used to diagnose pulmonary sarcoidosis. However, their combined diagnostic performances and safety profiles have not been comprehensively assessed.

Methods: We retrospectively analyzed 49 consecutive patients who underwent diagnostic bronchoscopy for suspected pulmonary sarcoidosis at a single center between June 2016 and December 2023. Patients were classified into five procedural groups based on the bronchoscopic modality used. The primary outcome was the diagnostic yield, and the secondary outcomes included adverse events and total procedure time.

Results: Histological confirmation was achieved in 87.8% of cases (43/49). The diagnostic yields were 93% for EBUS-TBNA alone, 71% for TBLC alone, and 100% when both were combined. This combination significantly outperformed each technique alone (p=0.003). TBLC did not significantly increase the procedure time or complications. Minor bleeding (grade 1) occurred in 12% of TBLC cases and was effectively managed. The diagnostic yield was positively associated with the number of biopsy samples and specific computed tomography (CT) patterns.

Conclusions: The combination of EBUS-TBNA and TBLC is a safe and highly effective diagnostic approach for pulmonary sarcoidosis, particularly in patients with nodular CT findings. This dual strategy may reduce the need for surgical biopsy and facilitate earlier diagnosis and treatment initiation.