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The diagnosis of [[sarcoidosis]] requires a tissue [[biopsy]], with the exception of rare circumstances which the clinical findings are highly specific for [[sarcoidosis]]. 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<ref>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.</ref>.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<ref>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.</ref>.
The diagnosis of [[sarcoidosis]] requires a tissue [[biopsy]], with the exception of rare circumstances which the clinical findings are highly specific for [[sarcoidosis]]. 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<ref>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.</ref>.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<ref>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.</ref>.


*[[Bronchoscopy]]: different samples can be taken with a bronchoscope:
*'''[[Bronchoscopy]]:''' different samples can be taken with a bronchoscope:
  a. '''[[Transbronchial biopsy]]''': 60-97% diagnostic for sarcoidosis<ref>Poe RH, Israel RH, Utell MJ, Hall WJ: Probability of a positive transbronchial
  a. '''[[Transbronchial biopsy(TBB)]]''': 60-97% diagnostic for sarcoidosis<ref>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.</ref><ref>Koerner SK, Sakowitz AJ, Appelman RI, et al: Transbronchinal lung
lung biopsy result in sarcoidosis. Arch Intern Med 139(Jul):761–763, 1979.</ref><ref>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.</ref><ref>Gilman MJ, Wang KP: Transbronchial lung biopsy in sarcoidosis. An
biopsy for the diagnosis of sarcoidosis. N Engl J Med 293(6):268–270, 1975.</ref><ref>Gilman MJ, Wang KP: Transbronchial lung biopsy in sarcoidosis. An
Line 18: Line 18:
sarcoidosis: a prospective study. Chest 120(1):109–114, 2001.</ref><ref>Kieszko R, Krawczyk P, Michnar M, et al: The yield of endobronchial
sarcoidosis: a prospective study. Chest 120(1):109–114, 2001.</ref><ref>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.</ref>.
biopsy in pulmonary sarcoidosis: connection between spirometric impairment and lymphocyte subpopulations in bronchoalveolar lavage luid. Respiration 71(1):72–76, 2004.</ref>.
  c.'''[[Transbronchial needle aspiration(TBNA)]]''': positive in 80% of patients with [[pulmonary sarcoidosis]]<ref>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.</ref>  
  c. '''[[Transbronchial needle aspiration(TBNA)]]''': positive in 80% of patients with [[pulmonary sarcoidosis]]<ref>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.</ref>  
 
d. '''[[Bronchoalveolar lavage(BAL)]]''': is a complementary test for the diagnosis of pulmonary sarcoidosis<ref>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.</ref>. BAL lymphocytosis(>15% lymphocytes) has a 90% sensivity<ref>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.</ref>. BAL CD4/CD8 ratio is increased more than 3.5 in 50% of patients with pulmonary sarcoidosis<ref>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.</ref><ref>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.</ref><ref>Winterbauer RH, Lammert J, Selland M, et al: Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest
104(2):352–361, 1993</ref>.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 15:08, 6 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.


Overview

The diagnosis of sarcoidosis requires a tissue biopsy, with the exception of rare circumstances which the clinical findings are highly specific sarcoidosis.

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. 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[1].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[2].

  • Bronchoscopy: different samples can be taken with a bronchoscope:
a. Transbronchial biopsy(TBB): 60-97% diagnostic for sarcoidosis[3][4][5].
b. Endobronchial biopsy: positive in 60% of patients with pulmonary sarcoidosis[6][7].
c. Transbronchial needle aspiration(TBNA): positive in 80% of patients with pulmonary sarcoidosis[8] 
d. Bronchoalveolar lavage(BAL): is a complementary test for the diagnosis of pulmonary sarcoidosis[9]. BAL lymphocytosis(>15% lymphocytes) has a 90% sensivity[10]. BAL CD4/CD8 ratio is increased more than 3.5 in 50% of patients with pulmonary sarcoidosis[11][12][13].

References

  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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Shorr AF, Torrington KG, Hnatiuk OW: Endobronchial biopsy for sarcoidosis: a prospective study. Chest 120(1):109–114, 2001.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ Winterbauer RH, Lammert J, Selland M, et al: Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest 104(2):352–361, 1993

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