Ultrasound evaluation of mediastinal lymphadenopathy in patients with sarcoidosis.

AIM: Mediastinal lymphadenopathy is a typical feature of pulmonary sarcoidosis and an important parameter for diagnosis and follow-up. The present feasibility study is the first to elucidate the role of transthoracic mediastinal ultrasonography (US) for evaluation and staging of lymphadenopathy in patients with sarcoidosis.

MATERIAL AND METHOD: Fifty patients with sarcoidosis were subjected to high-definition mediastinal US. The sonographic lymph node status was compared with the radiologic staging - the prevailing gold standard.

RESULTS: Mediastinal regions and landmarks could reliably be assessed by ultrasound in 45/50 (90%) of sarcoidosis patients. Lymphadenopathy was sonographically documented in 29/50 (58%) of the patients (sensitivity 89%, specificity 76%, PPV 86%, NPV 81%, accuracy 84%). There was a marked concordance between US confirmation of lymphadenopathy and radiologic staging (k=0.67, p<0.001).

CONCLUSIONS: Transthoracic US qualifies for the demonstration of the mediastinal regions and lymphadenopathy in patients with sarcoidosis. The procedure is facilitated by frequent and distinct mediastinal lymph node enlargement due to sarcoidosis. Prospective studies are required to find out whether mediastinal US adds value to conventional radiologic staging and provides a clinically advantage, particularly in the follow-up of patients with sarcoidosis.