Utility of Endomyocardial Biopsy in the Diagnosis of Cardiac Sarcoidosis

A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology

“…45,89,90 The diagnosis of isolated cardiac involvement is therefore difficult and laboratory abnormalities are non-specific. If the likelihood of an inflammatory cardiomyopathy remains high despite a negative endomyocardial biopsy, pursuing the diagnosis with repeated and image-guided biopsies of the myocardium or mediastinal lymph nodes is worthwhile and may markedly improve the detection rate of cardiac sarcoidosis.…”

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

“…Endomyocardial biopsy is the most specific detection method for CS, but a small tissue sample taken blindly from a myocardium with patchy granulomatous infiltration leads to diagnostic yield of only 20%, 34,35 precluding its routine usage. However, image-guided biopsy should be considered in patients without a prior history of systemic sarcoid who have unexplained arrhythmias or heart failure ( Figure 2).…”

Sarcoidosis and the heart: A review of the literature

“…Biopsies are commonly performed in the right ventricle, but they can be performed in the left ventricle (22). EMB can reveal some nonspecific findings like myocardial interstitial fibrosis, myofibril disarrangement and fragmentation, and inflammatory mononuclear cell infiltrates (16,36,96). The free wall of the right ventricle and apical interventricular septum are the most common locations where biopsy specimens are obtained, but sarcoid granulomas are mostly located in free wall of the left ventricle or the basal septum (3).…”

“…The free wall of the right ventricle and apical interventricular septum are the most common locations where biopsy specimens are obtained, but sarcoid granulomas are mostly located in free wall of the left ventricle or the basal septum (3). Because of the pathology and nonuniformity of sarcoid granulomas, those granulomas are seldom revealed by EMB (94)(95)(96). However, repeated and imaging-guided biopsies of the myocardium or mediastinal lymph nodes via CMR imaging or 18FDG-PET can be helpful and may improve the rate at which CS is detected (94).…”