ABSTRACT
Flexible bronchoscopy is an important tool for the diagnosis
of patients with sarcoidosis. It allows inspection and
sampling of the major airways and biopsy of the lung as
well as intrathoracic lymph nodes. Demonstration of non-
caseating granulomas is central to the diagnosis of sarcoid
along with consistent radiological and clinical features. A
clinical diagnosis without biopsy may only be made in
patients with classical Lo¨fgren’s syndrome (Iannuzzi et al.
2007). Prior to the introduction of flexible bronchoscopy by
Ikeda and colleagues in 1968, patients with pulmonary
sarcoidosis were required to undergo mediastinoscopy, rigid
bronchoscopy or open lung biopsy to establish a diagnosis.
Flexible bronchoscopy now allows endobronchial biopsy,
bronchoalveolar lavage, transbronchial lung biopsy and
transbronchial needle aspiration. Development of newer
endoscopes also allows endobronchial and endoscopic
ultrasound-guided sampling of mediastinal lymph nodes
which have an increasing role in the pathological evaluation
of intrathoracic lymph nodes in stage I and II sarcoidosis.
Evolution of technology has allowed further advances in the
bronchoscopy suite, including electromagnetic navigation
and confocal microscopy. These techniques are all discussed
in detail below.
