Atypical sarcoidosis diagnosed using endobronchial ultrasound-guided mediastinal lymph node biopsy with fine biopsy forceps: Two case reports

Both cases demonstrated non-caseating granulomatous inflammation on histopathology, elevated serum angiotensin-converting enzyme levels, and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid. Case 1 was observed after confirmation of stage II sarcoidosis, whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems. EBUS-TBFB can be used to make a definitive pathological diagnosis. For radiologically atypical sarcoidosis, EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples, thereby addressing the limitations of transbronchial needle aspiration cytology. This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.