Abstract：
Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate the non-caseating granulomas on histopathology. This review aims to synthesize current evidence related to tissue diagnosis of sarcoidosis using various bronchoscopic techniques. We start by discussing standard bronchoscopic techniques which have remained the cornerstone of diagnostic workup such as bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), conventional transbronchial needle aspiration (cTBNA) and transbronchial lung biopsy (TBLB) followed by newer modalities that incorporate real-time image guidance using endobronchial and endoscopic ultrasound. Although BAL, EBB, and TBLB have been employed as a diagnostic tool for several decades, their sensitivity and diagnostic yield is inferior to ultrasound-based endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). More recently, convincing evidence has also emerged to support the diagnostic accuracy and tissue yield of transbronchial lung cryobiopsy which will also be discussed in this review. These advances in bronchoscopic equipment and techniques over the last 2 decades have made it possible to obtain tissue samples using minimally invasive techniques thus avoiding invasive open lung biopsy and the risks that inherently follow. Up-to-date knowledge of these modalities is imperative for ensuring evidence-based medicine and improving patient-centric outcomes.
摘要：
结节病是一种多系统炎症性疾病，病因不清楚，通常会带来诊断挑战。通常需要进行组织诊断以说明组织病理学上的非干酪样肉芽肿。这篇综述旨在综合使用各种支气管镜技术进行结节病组织诊断的现有证据。我们首先讨论标准支气管镜技术，这些技术仍然是诊断检查的基石，例如支气管肺泡灌洗（BAL），支气管内活检(EBB),传统的经支气管针吸活检（cTBNA）和经支气管肺活检（TBLB），然后是使用支气管内和内窥镜超声进行实时图像引导的新模式。虽然BAL,EBB,TBLB已经被用作诊断工具几十年了，其敏感性和诊断率均低于基于超声的支气管内超声引导下经支气管针吸活检术(EBUS-TBNA)和内窥镜超声引导下细针吸活检术(EUS-FNA).最近,也出现了令人信服的证据来支持经支气管肺冷冻活检的诊断准确性和组织产量，这也将在本综述中进行讨论。在过去的20年里，支气管镜设备和技术的这些进步使得使用微创技术获得组织样本成为可能，从而避免了侵入性开放式肺活检和固有的风险。这些模式的最新知识对于确保循证医学和改善以患者为中心的结果至关重要。
