Fatma TOKGÖZ AKYIL, Soner Umut KÜVER, Selahattin ÖZTAŞ, Baran GÜNDOĞUŞ, Tülin SEVİM, Nurcan ÇETİN

Sarkoidozda endobronşiyal ultrasonografi eşliğinde mediastinal lenf nodu örneklemelerinde CD4+, CD8+ ve CD103+ T lenfositlerin tanısal değeri

Giriş: Bu çalışmanın amacı, lenf nodu örneklemelerinin flow sitometrik analizinde CD4+, CD8+ ve CD103+ lenfosit alt gruplarının, sarkoidozda yardımcı bir belirteç olarak tanısal değerini araştırmaktır. Materyal ve Metod: Çalışma tek merkezli, prospektif kohort çalışmasıdır. Ocak 2017-Eylül 2017 tarihleri arasında ayırıcı tanısında sarkoidoz düşünülerek endobronşiyal ultrasonografi (EBUS) eşliğinde lenf nodu örneklemesi yapılan 46 hasta çalışmaya dahil edildi. Lenf nodu örneklerinde, farklı lenfosit alt grupları flow sitometri sayıldı ve karşılaştırıldı. Son tanıya göre hastalar sarkoidoz ve sarkoidoz dışı olmak üzere iki gruba ayrıldı. Lenfosit alt grup analizleri her iki grup arasında karşılaştırıldı. Bulgular: Son tanı 31 (%67) hastada sarkoidoz, 15 (%33) hastada sarkoidoz dışı (akciğer kanseri, antrakoz, pnömokonyoz, pulmoner emboli, pnömoni) idi. Total hücre sayıları ve lenfosit oranları, CD8+ T lenfosit yüzdeleri ve CD4/CD8 oranları her iki grup arasında benzer bulunmuştur (p> 0.05). CD4+ T lenfosit oranları sarkoidoz hastalarında daha yüksek saptanmıştır (p= 0.017). Sarkoidoz hastalarında, CD103+CD4+ ve CD103+CD8+ lenfosit yüzdeleri daha düşük tespit edilmiştir (sırasıyla, p= 0.008 ve p= 0.048). CD103+CD4+/CD4+ oranı sarkoidoz hastalarında daha düşük bulunmuştur (p= 0.014). Sonuç: EBUS ile alınan lenf nodu materyallerinin sitolojik incelemesi sarkoidozun ayırıcı tanısında önemli ipuçları sağlayabilir. Sarkoidoz hastalarında CD4+ lenfosit hücre sayıları daha yüksek olsa da CD4/CD8 oranının tanıya katkısı sınırlıdır. Düşük CD103+CD4+ ve CD103+CD8+ T lenfositlerin sarkoidoz tanısında belirleyici olacağı saptanmıştır.

Diagnostic value of CD4+, CD8+ and CD103+ lymphocytes in mediastinal lymph node specimens obtained via endobronchial ultrasonography for sarcoidosis

Introduction: The aim of the present study is to investigate the diagnosticvalue of the CD4+, CD8+ and CD103+ lymphocyte sub-groups in mediastinallymph nodes, as an adjunctive marker in sarcoidosis.Materials and Methods: The present study is a single-center, prospectivecohort study designed in a reference center for chest diseases. Forty-six patients who underwent endobronchial ultrasound (EBUS)-guided mediastinallymph node sampling with a preliminary diagnosis of sarcoidosis were enrolled. The different lymphocyte subgroups were counted by flow cytomeytry inlymph node biopsy samples. Based on the final diagnosis, subjects were divided into two groups: sarcoidosis and non-sarcoidosis. Lymphocyte subsetanalysis were compared between the groups.Results: The final diagnoses were sarcoidosis in 31 (67%) and non-sarcoidosisin 15 patients (33%). The total cell counts, lymphocyte ratios, CD8+ Tlymphocyte ratios and CD4/CD8 ratios were similar in both groups (p> 0.05).CD4+ T lymphocyte rates were higher in patients with sarcoidosis (p= 0.017).CD103 subset analysis revealed significantly lower CD103+CD4+,CD103+CD8+ lymphocytes and CD103+CD4+/CD4+ ratios in sarcoidosis(p= 0.008, p= 0.048, p= 0.014, respectively).Conclusion: Cytological examination of EBUS-guided lymph node samples may provide substantial findings in differential diagnosisof sarcoidosis. Patients with sarcoidosis have higher CD4+ lymphocytes, lower CD103+CD4+ lymphocytes and CD103+CD4+/CD4+and CD103+CD8+ lymphocyte ratios. These subsets of lymphocytes in lymph node biopsies may be novel predictors of sarcoidosisdiagnosis.

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