BTS Clinical Statement on pulmonary sarcoidosis

Thillai, Muhunthan; Atkins, Christopher; Crawshaw, Anjali; Hart, Simon P.; Ho, Ling-Pei; Kouranos, Vasileios; Patterson, Karen; Screaton, Nicholas; Whight, Joanna; Wells, Athol U.

doi:10.1136/thoraxjnl-2019-214348

Cited by 115 publications

(152 citation statements)

References 137 publications

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“…Patients who undergo annual chest CT can accumulate over 100 mSv of exposure in their lifetime [ 8 , 9 ]. According to guidelines, surveillance CT—due to its high sensitivity in depicting lung abnormalities—is recommended in patients with unexplained deterioration in symptoms or lung function, those with “red flags” such as hemoptysis or pulmonary hypertension, or when specific conditions are suspected radiographically (such as aspergilloma) [ 4 ].…”

Section: Diagnostic Assessmentmentioning

confidence: 99%

“…Computed Tomography (CT) is more sensitive than CXR in identifying lymphadenopathies and in depicting subtle parenchymal abnormalities [ 3 ], and it is superior to CXR in identifying pulmonary fibrosis, which represents the end-stage of this disease [ 4 ]. CT is therefore extremely helpful in the diagnostic work up when there is discordance between clinical data and radiographic features or when the latter are atypical.…”

Section: Introductionmentioning

confidence: 99%

“…The latest British Thoracic Society (BTS) statement on pulmonary sarcoidosis confirms the central role of CXR in diagnostic assessment and monitoring of the disease but focuses more on the utility of CT scans, that may prevent the need of invasive sampling (endobronchial ultrasound—EBUS—or transbronchial biopsies) in the presence of typical CT features. However, also typical CT findings associated with a confident clinical diagnosis might require a multidisciplinary team (MDT) discussion to assess the potential need of biopsy [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prognostic assessment in sarcoidosis still relies on a four-level staging system based on radiographic appearance, conceived by Scadding in 1961, nearly sixty years ago, that goes from stage 0—normal findings—to stage IV—lung fibrosis with no chance of clinical and radiographic resolution if untreated [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, despite the advances in chest imaging modalities including the wider use of radiation-saving techniques, the ever-increasing applications of chest magnetic resonance (MR), and the introduction of objective and quantitative techniques, according to guidelines, diagnostic and prognostic assessment in sarcoidosis seems to be stuck on CXR [ 2 , 4 ]. In this review, we aim to describe the latest novelties in diagnostic and prognostic assessment of thoracic sarcoidosis—focusing on imaging of lung abnormalities and lymphadenopathies—and outline potential research fields, which have not been explored in this disease yet.…”

Section: Introductionmentioning

confidence: 99%

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Novelties in Imaging of Thoracic Sarcoidosis

Calandriello

D’Abronzo

Pasciuto

et al. 2021

JCM

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Sarcoidosis is a systemic granulomatous disease affecting various organs, and the lungs are the most commonly involved. According to guidelines, diagnosis relies on a consistent clinical picture, histological demonstration of non-caseating granulomas, and exclusion of other diseases with similar histological or clinical picture. Nevertheless, chest imaging plays an important role in both diagnostic assessment, allowing to avoid biopsy in some situations, and prognostic evaluation. Despite the demonstrated lower sensitivity of chest X-ray (CXR) in the evaluation of chest findings compared to high-resolution computed tomography (HRCT), CXR still retains a pivotal role in both diagnostic and prognostic assessment in sarcoidosis. Moreover, despite the huge progress made in the field of radiation dose reduction, chest magnetic resonance (MR), and quantitative imaging, very little research has focused on their application in sarcoidosis. In this review, we aim to describe the latest novelties in diagnostic and prognostic assessment of thoracic sarcoidosis and to identify the fields of research that require investigation.

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Section: Diagnostic Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Novelties in Imaging of Thoracic Sarcoidosis

Calandriello

D’Abronzo

Pasciuto

et al. 2021

JCM

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Diagnosis and Treatment of Pulmonary Sarcoidosis

Belperio

Shaikh

Abtin

et al. 2022

JAMA

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ImportanceSarcoidosis is an inflammatory granulomatous disease of unknown cause that affects an estimated 2 to 160 people per 100 000 worldwide and can involve virtually any organ. Approximately 10% to 30% of patients with sarcoidosis develop progressive pulmonary disease.ObservationAmong patients with pulmonary sarcoidosis, the rate of spontaneous remission without serious sequelae ranges from 10% to 82%. However, lung disease progression occurs in more than 10% of patients and can result in fibrocystic architectural distortion of the lung, which is associated with a mortality rate of 12% to 18% within 5 years. Overall, the mortality rate for sarcoidosis is approximately 7% within a 5-year follow-up period. Worldwide, more than 60% of deaths from sarcoidosis are due to pulmonary involvement; however, more than 70% of deaths from sarcoidosis are due to cardiac involvement in Japan. Up to 70% of patients with advanced pulmonary sarcoidosis develop precapillary pulmonary hypertension, which is associated with a 5-year mortality rate of approximately 40%. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues. Although optimal doses of oral glucocorticoids for pulmonary sarcoidosis are unknown, oral prednisone typically starting at a dose of 20 mg/d to 40 mg/d for 2 to 6 weeks is recommended for patients who are symptomatic (cough, dyspnea, and chest pain) and have parenchymal infiltrates and abnormal pulmonary function test results. Oral glucocorticoids can be tapered over 6 to 18 months if symptoms, pulmonary function test results, and radiographs improve. Prolonged use of oral glucocorticoids may be required to control symptoms and stabilize disease. Patients without adequate improvement while receiving a dose of prednisone of 10 mg/d or greater or those with adverse effects due to glucocorticoids may be prescribed immunosuppressive agents, such as methotrexate, azathioprine, or an anti–tumor necrosis factor medication, either alone or with glucocorticoids combined with appropriate microbial prophylaxis for Pneumocystis jiroveci and herpes zoster. Effective treatments are not available for advanced fibrocystic pulmonary disease.Conclusions and RelevanceSarcoidosis has a mortality rate of approximately 7% within a 5-year follow-up period. More than 10% of patients with pulmonary sarcoidosis develop progressive disease and more than 60% of deaths are due to advanced pulmonary sarcoidosis. Oral glucocorticoids with or without another immunosuppressive agent are the first-line therapy for symptomatic patients with abnormal pulmonary function test results and lung infiltrates. Patients with sarcoidosis and precapillary pulmonary hypertension should be treated with therapies such as phosphodiesterase inhibitors and prostacyclin analogues.

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T‐cell signature cytokines distinguish pulmonary sarcoidosis from pulmonary tuberculosis

et al. 2023

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Sarcoidosis is a systemic inflammatory disorder characterized by tissue infiltration due to mononuclear phagocytes and lymphocytes and associated noncaseating granuloma formation. Pulmonary sarcoidosis (PS) shares a number of clinical, radiological, and histopathological characteristics with that of pulmonary tuberculosis (PTB). Due to this, clinicians face issues in differentiating between PS and PTB in a substantial number of cases. There is a lack of any specific biomarker that can diagnose PS distinctively from PTB. We compared T‐cell‐based signature cytokines in patients with PS and PTB. In this study, we proposed a serum biomarker panel consisting of cytokines from cells: T helper (Th) 1 [interferon‐gamma (IFN‐γ); tumor necrosis factor‐alpha (TNF‐α)], Th9 [interleukin (IL)‐9], Th17 [IL‐17], and T regulatory (Treg) [IL‐10; transforming growth factor‐beta (TGF‐β)]. We performed the principal component analysis that demonstrated that our serum cytokine panel has a significant predictive ability to differentiate PS from PTB. Our results could aid clinicians to improve the diagnostic workflow for patients with PS in TB endemic settings where the diagnosis between PS and PTB is often ambiguous.

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BTS Clinical Statement on pulmonary sarcoidosis

Cited by 115 publications

References 137 publications

Novelties in Imaging of Thoracic Sarcoidosis

Novelties in Imaging of Thoracic Sarcoidosis

Diagnosis and Treatment of Pulmonary Sarcoidosis

T‐cell signature cytokines distinguish pulmonary sarcoidosis from pulmonary tuberculosis

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