Granulomatoses diagnostiquées par cytoponctions ganglionnaires trans-bronchiques

Abstract

Objectif: décrire la population présentant des granulomes épithélioïdes sur les cyto-ponctions ganglionnaires transbronchiques et analyser leurs significations cliniques. Méthode: inclusion prospective monocentrique de tous les patients ayant bénéficié de ponctions ganglionnaires transbronchiques, échoguidées ou non, sur 3 ans. Résultats: sur 329 patients, 59 présentaient des granulomes (18%) : 43 cas de sarcoïdose (73%), 8 cas de tuberculose (14%) et 8 autres diagnostics. Etaient réalisées 5,7 ponctions par patients, sans complication. Les sarcoïdoses étaient de stade I et II pour plus de 90% des patients, 32% avaient d autres organes atteints, et 42% ont nécessité un traitement spécifique. La sensibilité de la technique pour le diagnostic de granulomatose était de 89%. Conclusion: des granulomes, correspondant surtout à des sarcoïdoses, sont fréquemment retrouvés lors des ponctions ganglionnaires transbronchiques. Cet examen pourrait être intégré dans le bilan diagnostique des granulomatoses.Purpose: the aim of our study was to define the frequency of granulomatosis diagnosed by transbronchial needle aspiration (TNBA), assess the clinical meaning of this result and describe technical details of the procedure. Methods: in a monocentricprospective study, we included all patients who underwent a TNBA with or without endobronchial ultrasound (EBUS), over three years. An extemporaneous cytological examination by an on site cytologist was mandatory. At least six months follow-up were needed to confirm the diagnosis. Results: during this period, 329 patients underwent a TBNA, without any complication. A median of five fine needle aspiration (FNA) per endoscopy were performed, and granulomas were found in 59 cases. In seven false-negative cases, the granulomatous disease could not be diagnosed by the procedure. The sensitivity of TNBA in diagnosing granulomatosis was 89%. Diagnoses were as follow: 49 sarcoidosis (74%), 9 tubercolosis (14%) and 8 other granulomatosis including three sarcoidal reactions in regional lymph nodes of a malignant disease. Sarcoidosis were stage I and II in over 90% of patients, 32% had at least another organ affected, and 42% required a specific treatment. The CD4/CD8 lymphocyte rate in lymph node aspirates had no diagnostic value. Conclusion: granulomatosis, consisting mainly in sarcoidosis, are frequently found during TBNA procedures. Cytological diagnosis of granulomas on FNA is reliable and can be integrated in the diagnostic workup of granulomatosis.ST QUENTIN EN YVELINES-BU (782972101) / SudocSudocFranceF