The histopathological evaluation of mediastinal lymph node stations in sarcoidosis

Abstract

WOS: 000304300200006Background: Even if the clinical and radiological findings indicate sarcoidosis, diagnosis can be established by showing histopathologically the sarcoid granulomas in the tissue. Mediastinoscopy is a surgical procedure that is commonly used to obtain histological specimens to examine for mediastinal lymph node involvement in sarcoidosis. Objective: To demonstrate which of the mediastinal lymph node stations that the biopsies were taken had the highest diagnostic value for histopathological examination in sarcoidosis. Methods: Operative and histopathology reports of 14 patients who underwent mediastinoscopy and diagnosed with sarcoidosis in the Thoracic Surgery Clinic of Duzce University School of Medicine, between January 2009 and January 2011 were reviewed retrospectively. Results: On thorax tomography images of the patients with sarcoidosis, lymph nodes of the bilateral lower paratracheal and hilar mediastinal lymph node stations were frequently enlarged to pathological dimensions. In the majority of the cases, biopsies were taken by mediastinoscopy from the bilateral lower paratracheal lymph node stations. Histopathological examination of the biopsy material showed severe noncaseating granulomatous inflammation, most commonly in the right lower paratracheal, followed by left lower paratracheal and at least common highest mediastinal lymph node stations. Conclusions: During mediastinoscopy to be performed on patients with suspected sarcoidosis, we recommend that priority be given to taking biopsies from the lower paratracheal lymph nodes and sent for frozen examination for definitive diagnosis to prevent unnecessary mediastinal dissection that might result in serious complications