Current Diagnostic Techniques in Sarcoidosis

Abstract

Sarcoidosis is an enigmatic disorder with a propensity for lung involvement in the majority of cases (~90%) and is characterized by noncaseating granulomatous inflammation on histological analysis. The techniques to establish the diagnosis have evolved over time, and a clear diagnostic algorithm for the clinicians dealing with this disease is desirable. Thoracic computed tomography is the imaging modality of choice in pulmonary sarcoidosis and provides accurate assessment of staging, parenchymal involvement, and response to immunomodulatory therapies. The advent of EBUS-TBNA has been a step forward with an excellent diagnostic yield in the presence of mediastinal/hilar lymphadenopathy and has replaced the traditional approach of obtaining biopsy samples via transbronchial and endobronchial routes. The preferred initial investigation for the confirmation of diagnosis is dependent on the organ involvement and the expertise available. A core biopsy of cervical lymph nodes is a less invasive and economical alternative in selected cases of suspected pulmonary sarcoidosis and warrants further evaluation in prospective manner to establish if it can be considered as a first-line investigation in all new cases suspected to have pulmonary sarcoidosis. A multidisciplinary approach is crucial for the diagnosis and management, and a simplified algorithm is proposed to help guide clinicians dealing with this disease of myriad clinical and radiological manifestations.

Educational Case: Immune and inflammatory diseases: A case of pulmonary sarcoidosis

“…Transbronchial bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has an excellent diagnostic yield in the presence of mediastinal/hilar lymphadenopathy and has replaced the traditional approach of obtaining biopsy samples via transbronchial and endobronchial routes. 6 The use of a surgical lung biopsy may be warranted when the results with another procedure are not definitive and a biopsy of the mediastinal lymph nodes, the lung, or both is required. 6 This can generally be done with minimally invasive procedures such as video assisted thoracoscopic surgery (VATS).…”

“… 6 The use of a surgical lung biopsy may be warranted when the results with another procedure are not definitive and a biopsy of the mediastinal lymph nodes, the lung, or both is required. 6 This can generally be done with minimally invasive procedures such as video assisted thoracoscopic surgery (VATS).…”