Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Sarcoidosis other diagnostic studies
Introduction
Overview
Overview
The diagnosis of sarcoidosis requires a tissue biopsy, with the exception of rare circumstances which the clinical findings are highly specific for sarcoidosis. The evaluation of pulmonary disease in sarcoidosis patients relies on three major factors: pulmonary function, chest imaging, and symptoms.
Tissue biopsy
Tissue biopsy
The diagnosis of sarcoidosis requires a tissue biopsy, with the exception of rare circumstances which the clinical findings are highly specific for sarcoidosis[1]. It is ideal for biopsy to be minimally invasive and associated with the least morbidity. Thus, peripheral biopsy sites are preferred compared to visceral organs[2].When there is no evidence that a superficial peripheral site is involved by sarcoidosis, a biopsy is usually performed in organs which is very often the lung, because the lungs are involved in 90% of sarcoidosis patients[3].
different samples can be taken with a bronchoscope:
Transbronchial biopsy(TBB)
Endobronchial biopsy
- positive in 60% of patients with pulmonary sarcoidosis[7][8].
Transbronchial needle aspiration(TBNA)
- positive in 80% of patients with pulmonary sarcoidosis[9]
Bronchoalveolar lavage(BAL)
- is a complementary test for the diagnosis of pulmonary sarcoidosis[10]. BAL lymphocytosis(>15% lymphocytes) has a 90% sensivity[11]. BAL CD4/CD8 ratio is increased more than 3.5 in 50% of patients with pulmonary sarcoidosis[12][13][14].
Extrapulmonary tissue biopsy
Granulomas can be detected in any organ which is involved by sarcoidosis[2]
When the diagnosis can be made without performing a tissue biopsy?
When the diagnosis can be made without performing a tissue biopsy?
in some clinical scenarios, the presentation is so specific that the diagnosis can be made without a confirmatory tissue biopsy[1].
- Lupus pernio
- Lofgren syndrome
- Heerfordt syndrome
- Bilateral hilar adenopathy on CXR without symptoms
- Positive panda and/or lambda sign on gallium scan
Pulmonary Function Tests
- Significant amount of patients with pulmonary sarcoidosis will have a normal spirometry and lung volumes at the time of diagnosis, but over time some of these individuals will develope a restrictive pattern, with reduction of lung volumes[15][16][17][18].
References
References
- ↑ 1.0 1.1 Judson MA: The diagnosis of sarcoidosis. Clin Chest Med 29(3):415– 427, 2008.
- ↑ 2.0 2.1 Teirstein AS, Judson MA, Baughman RP, et al: The spectrum of biopsy sites for the diagnosis of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 22(2):139 146, 2005.
- ↑ Baughman RP, Teirstein AS, Judson MA, et al: Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 164:1885–1889, 2001.
- ↑ Poe RH, Israel RH, Utell MJ, Hall WJ: Probability of a positive transbronchial lung biopsy result in sarcoidosis. Arch Intern Med 139(Jul):761–763, 1979.
- ↑ Koerner SK, Sakowitz AJ, Appelman RI, et al: Transbronchinal lung biopsy for the diagnosis of sarcoidosis. N Engl J Med 293(6):268–270, 1975.
- ↑ Gilman MJ, Wang KP: Transbronchial lung biopsy in sarcoidosis. An approach to determine the optimal number of biopsies. Am Rev Respir Dis 122(5):721–724, 1980.
- ↑ Shorr AF, Torrington KG, Hnatiuk OW: Endobronchial biopsy for sarcoidosis: a prospective study. Chest 120(1):109–114, 2001.
- ↑ Kieszko R, Krawczyk P, Michnar M, et al: The yield of endobronchial biopsy in pulmonary sarcoidosis: connection between spirometric impairment and lymphocyte subpopulations in bronchoalveolar lavage luid. Respiration 71(1):72–76, 2004.
- ↑ Agarwal R, Srinivasan A, Aggarwal AN, Gupta D: Eficacy and safety of convex probe EBUS-TBNA in sarcoidosis: a systematic review and meta-analysis. Respir Med 106(6):883–892, 2012.
- ↑ Meyer KC, Raghu G, Baughman RP, et al: An oficial American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med 185(9):1004–1014, 2012.
- ↑ Drent M, van Nierop MA, Gerritsen FA, et al: A computer program using BALF-analysis results as a diagnostic tool in interstitial lung diseases. Am J Respir Crit Care Med 153(2):736–741, 1996.
- ↑ Welker L, Jorres RA, Costabel U, Magnussen H: Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases. Eur Respir J 24(6):1000–1006, 2004.
- ↑ Drent M, Wagenaar SS, Mulder PH, et al: Bronchoalveolar lavage fluid proiles in sarcoidosis, tuberculosis, and non-Hodgkin’s and Hodgkin’s disease. An evaluation of differences. Chest 105(2):514– 519, 1994.
- ↑ Winterbauer RH, Lammert J, Selland M, et al: Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest 104(2):352–361, 1993
- ↑ Baughman RP, Teirstein AS, Judson MA, et al: Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 164:1885–1889, 2001.
- ↑ Loddenkemper R, Kloppenborg A, Schoenfeld N, et al: Clinical indings in 715 patients with newly detected pulmonary sarcoidosis–results of a cooperative study in former West Germany and Switzerland. WATL Study Group. Wissenschaftliche Arbeitsgemeinschaft fur die Therapie von Lungenkrankheitan. Sarcoidosis Vasc Diffuse Lung Dis 15(2):178–182, 1998.
- ↑ Baughman RP, Winget DB, Bowen EH, Lower EE: Predicting respiratory failure in sarcoidosis patients. Sarcoidosis 14:154–158, 1997.
- ↑ Judson MA, Baughman RP, Thompson BW, et al: Two year prognosis of sarcoidosis: the ACCESS experience. Sarcoidosis Vasc Diffuse Lung Dis 20(3):204–211, 2003.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.