Trial for the Diagnosis of Sarcoidosis

NCT ID: NCT00872612

Last Updated: 2015-12-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

304 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-03-31

Study Completion Date

2012-05-31

Brief Summary

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This randomized study investigates two different diagnostic strategies for patients with suspected pulmonary sarcoidosis stage I/II.

The objective is to assess the role of endosonography (EBUS/ EUS - FNA) in demonstrating non-caseating granulomas in comparison with conventional bronchoscopy (TBLB + EBB).

Also the researchers investigate the additional value of BAL, in relation to endosonography and conventional bronchoscopy (TBLB + EBB), in diagnosing sarcoidosis.

Thirdly the researchers aim to assess the rate of complications in both the endosonography and conventional bronchoscopic workup.

Detailed Description

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Sarcoidosis is the most prevalent interstitial lung disease in Western-Europe and the US. The disease is most prevalent in young adults. To set the final diagnosis of sarcoidosis, the following parameters need to be present:

1. A clinical and radiological suspicion of sarcoidosis stage I/II.
2. A tissue diagnosis of disease-specific non-caseating granulomas.
3. Exclusion of possible alternative diagnoses as lung cancer or tuberculosis.

Nowadays, a bronchoscopy with lung biopsies is advised to set a tissue diagnosis of sarcoidosis. However, these biopsies are only diagnostic in 70% of the procedures and they are associated with a 3% risk of coughing up blood and a 4% risk of a lung collapse.

Since recently, a new diagnostic procedure has come available. This procedure, endo-sonography, makes it possible to biopsy lymph nodes in the chest under direct visualization and has a diagnostic accuracy of 85%. The associated risk of complications appears to be small (\<1%)

We consider the current standard for the diagnostics of sarcoidosis to be outdated, considering the clinical availability of endo-sonography. We expect that endo-sonography is more frequent diagnostic for a tissue diagnosis of sarcoidosis.

Also we hypothesize that this technique is safer and more preferred by patients.

Conditions

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Sarcoidosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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A

Endosonography arm

Group Type EXPERIMENTAL

EUS-FNA/EBUS-TBNA + BAL

Intervention Type PROCEDURE

EUS-FNA = Endoscopic Ultrasound guided fine needle aspiration of mediastinal lymph nodes.

EBUS-TBNA = Endobronchial Ultrasound guided transbronchial needle aspiration of mediastinal and hilar lymph nodes.

BAL = bronchoalveolar lavage

B

Conventional bronchoscopy arm

Group Type ACTIVE_COMPARATOR

EBB + TBLB + BAL

Intervention Type PROCEDURE

EBB = Endobronchial biopsy TBLB = Transbronchial biopsy BAL = Bronchoalveolar lavage

Interventions

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EUS-FNA/EBUS-TBNA + BAL

EUS-FNA = Endoscopic Ultrasound guided fine needle aspiration of mediastinal lymph nodes.

EBUS-TBNA = Endobronchial Ultrasound guided transbronchial needle aspiration of mediastinal and hilar lymph nodes.

BAL = bronchoalveolar lavage

Intervention Type PROCEDURE

EBB + TBLB + BAL

EBB = Endobronchial biopsy TBLB = Transbronchial biopsy BAL = Bronchoalveolar lavage

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with suspected pulmonary sarcoidosis stage I/ II
* Age \> 18 years
* Both males and females
* Written informed consent is obtained.

Exclusion Criteria

* Patients with obvious other organ involvement of sarcoidosis where a simple diagnostic biopsy to assess granulomas can be performed.
* Löfgren's syndrome
* Inability to undergo fiberbronchoscopy, EBUS or EUS (e.g. respiratory insufficiency, esophageal stenosis
* Contraindications for a lung or nodal biopsy (e.g. coagulopathy, thrombocytopenia)
* Pregnancy
* Inability to obtain informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Leiden University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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M.B. von Bartheld

MB von Bartheld, MSc. PhD Student

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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M B von Bartheld, MSc

Role: STUDY_DIRECTOR

Pulmonary Department, Leiden University Medical Center

J T Annema, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Pulmonary Department, Leiden University Medical Center

K F Rabe, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Pulmonary Department, Leiden University Medical Center

Locations

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Universitair Ziekenhuis Gent

Ghent, , Belgium

Site Status

Gentofte Hospital Copenhagen

Hellerup, Copenhagen, Denmark

Site Status

Thoraxklinik Heidelberg

Heidelberg, Baden-Wurttemberg, Germany

Site Status

Hospital Grosshansdorf

Großhansdorf, Schleswig-Holstein, Germany

Site Status

Rijnstaete Ziekenhuis

Arnhem, Gelderland, Netherlands

Site Status

Radboud Universitair Medisch Centrum

Nijmegen, Gelderland, Netherlands

Site Status

St. Catharina Ziekenhuis

Eindhoven, North Brabant, Netherlands

Site Status

Pulmonary Department, Leiden University Medical Center

Leiden, South Holland, Netherlands

Site Status

Erasmus Medisch Centrum

Rotterdam, South Holland, Netherlands

Site Status

St. Franciscus Ziekenhuis

Rotterdam, South Holland, Netherlands

Site Status

Medisch Centrum Haaglanden

The Hague, South Holland, Netherlands

Site Status

University hospital Krakow, J.P. II

Krakow, , Poland

Site Status

Sokołowski Pulmonary Hospital

Zakopane, , Poland

Site Status

Royal Brompton Hospital

London, London, United Kingdom

Site Status

Chelsea and Westminster hospital

London, , United Kingdom

Site Status

Countries

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Belgium Denmark Germany Netherlands Poland United Kingdom

References

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Costabel U, Hunninghake GW. ATS/ERS/WASOG statement on sarcoidosis. Sarcoidosis Statement Committee. American Thoracic Society. European Respiratory Society. World Association for Sarcoidosis and Other Granulomatous Disorders. Eur Respir J. 1999 Oct;14(4):735-7. doi: 10.1034/j.1399-3003.1999.14d02.x. No abstract available.

Reference Type BACKGROUND
PMID: 10573213 (View on PubMed)

Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007 Nov 22;357(21):2153-65. doi: 10.1056/NEJMra071714. No abstract available.

Reference Type BACKGROUND
PMID: 18032765 (View on PubMed)

Winterbauer RH, Lammert J, Selland M, Wu R, Corley D, Springmeyer SC. Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest. 1993 Aug;104(2):352-61. doi: 10.1378/chest.104.2.352.

Reference Type BACKGROUND
PMID: 8339618 (View on PubMed)

Kantrow SP, Meyer KC, Kidd P, Raghu G. The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis. Eur Respir J. 1997 Dec;10(12):2716-21. doi: 10.1183/09031936.97.10122716.

Reference Type BACKGROUND
PMID: 9493649 (View on PubMed)

Annema JT, Veselic M, Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Eur Respir J. 2005 Mar;25(3):405-9. doi: 10.1183/09031936.05.00098404.

Reference Type BACKGROUND
PMID: 15738281 (View on PubMed)

Garwood S, Judson MA, Silvestri G, Hoda R, Fraig M, Doelken P. Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis. Chest. 2007 Oct;132(4):1298-304. doi: 10.1378/chest.07-0998. Epub 2007 Sep 21.

Reference Type BACKGROUND
PMID: 17890467 (View on PubMed)

von Bartheld MB, Dekkers OM, Szlubowski A, Eberhardt R, Herth FJ, in 't Veen JC, de Jong YP, van der Heijden EH, Tournoy KG, Claussen M, van den Blink B, Shah PL, Zoumot Z, Clementsen P, Porsbjerg C, Mauad T, Bernardi FD, van Zwet EW, Rabe KF, Annema JT. Endosonography vs conventional bronchoscopy for the diagnosis of sarcoidosis: the GRANULOMA randomized clinical trial. JAMA. 2013 Jun 19;309(23):2457-64. doi: 10.1001/jama.2013.5823.

Reference Type DERIVED
PMID: 23780458 (View on PubMed)

Other Identifiers

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LUMC-GRANULOMA

Identifier Type: -

Identifier Source: org_study_id