Value of s-ACE, BAL lymphocytosis, and CD4+/CD8+ and CD103+CD4+/CD4+ T-cell ratios in diagnosis of sarcoidosis

Hyldgaard, Charlotte; Kaae, Susanne S.; Riddervold, Mette; Hoffmann, Hans Jürgen; Hilberg, Ole

doi:10.1183/09031936.00144311

Cited by 30 publications

(27 citation statements)

References 8 publications

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“…Heron et al [16] and Mota et al [17] also reported a good discriminative power of the CD103+CD4+/CD4+ ratio (table 5). However, in another study by Hyldgaard et al [18], the combination of CD4+/CD8+ and CD103+CD4+/CD4+ ratios had a sensitivity of only 42% and a specificity of 91%, which led to conclude that the combination of these ratios was a poor marker for sarcoidosis. Of note, all those studies had small study populations (table 5), and two of them included less than 20 cases with sarcoidosis [15,18].…”

Section: Discussionmentioning

confidence: 96%

“…Four studies analyzing the CD103+CD4+/CD4+ ratio in sarcoidosis, either alone or in combination with the CD4+/CD8+ ratio, have been previously performed [15,16,17,18]. The cut-off values defined in those studies to discriminate between sarcoidosis and other diagnoses were applied to our study population for comparison (table 5).…”

Section: Resultsmentioning

confidence: 99%

“…Four previous studies have investigated the CD103 integrin on CD4+ T lymphocytes in BALF as a putative marker for sarcoidosis [15,16,17,18], and several of them have suggested that a high CD4+/CD8+ ratio combined with a low CD103+CD4+/CD4+ ratio would allow to distinguish sarcoidosis from other causes of alveolar lymphocytosis. Kolopp-Sarda et al [15] first reported that the combination of a CD4+/CD8+ ratio >2.5 and a CD103+CD4+/CD4+ ratio <0.31 had a sensitivity of 96% to discriminate between sarcoidosis and other causes of lymphocytic alveolitis.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Mota et al [17] found a 98% sensitivity. However, two other studies showed a lower performance of the CD103+CD4+/CD4+ ratio as a diagnostic marker for sarcoidosis [16,18]. The goal of the present study was to further investigate the value of the CD103+CD4+/CD4+ ratio to differentiate sarcoidosis from other causes of lymphocytic alveolitis in a large retrospective case series.…”

Section: Introductionmentioning

confidence: 99%

“…As the peripheral blood CD4+ lymphocytes do not express CD103, differential expression of this marker on BALF CD4+ lymphocytes could serve as a diagnostic marker of sarcoidosis as compared to other ILDs. Several retrospective studies have explored this issue [13,15,16,17,18]. Kolopp-Sarda et al [15] found that a high CD4+/CD8+ ratio combined with a low CD103+CD4+/CD4+ ratio allowed to distinguish sarcoidosis from other ILDs with a 96% sensitivity.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Value of the CD103+CD4+/CD4+ Ratio to Differentiate Sarcoidosis from Other Causes of Lymphocytic Alveolitis

Bretagne

Diatta²,

Faouzi³

et al. 2016

Respiration

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Background: The CD103 integrin is present on CD4+ lymphocytes of the bronchial mucosa, but not on peripheral blood CD4+ lymphocytes. It has been hypothesized that CD4+ lymphocytes in pulmonary sarcoidosis originate from redistribution from the peripheral blood to the lung, and therefore do not bear the CD103 integrin. Some data suggest that a low CD103+ percentage among bronchoalveolar lavage fluid (BALF) CD4+ lymphocytes discriminates between sarcoidosis and other diagnoses. Objective: To determine the diagnostic value of BALF CD103+ to identify sarcoidosis among other causes of alveolar lymphocytosis in a large retrospective case series. Methods: Among 391 consecutive bronchoalveolar lavages performed at our institution and analyzed by flow cytometry, we identified 207 cases, which were grouped into nine diagnostic categories: sarcoidosis, tuberculosis, non-tuberculous infections, hypersensitivity pneumonitis, non-specific interstitial pneumonia, organizing pneumonia, drug-induced lung diseases, other interstitial lung diseases (ILDs), and other diagnoses. To assess the discriminative value of the CD103+CD4+/CD4+ ratio to distinguish sarcoidosis from other entities, areas under ROC curves (AUC) were calculated. Results: Sarcoidosis patients (n = 53) had significantly lower CD103+CD4+/CD4+ ratios than patients in other diagnostic categories. The AUC was 62% for sarcoidosis compared to all other diagnoses, and 69% for sarcoidosis compared to other ILDs. When combining CD103+CD4+/CD4+ and CD4+/CD8+ ratios, the AUC increased to 76 and 78%, respectively. When applying previously published cut-offs to our population, the AUC varied between 54 and 73%. Conclusions: The CD103+CD4+/CD4+ ratio does not accurately discriminate between sarcoidosis and other causes of lymphocytic alveolitis, neither alone nor in combination with the CD4+/CD8+ ratio, and is not a powerful marker for the diagnosis of sarcoidosis.

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Section: Discussionmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Value of the CD103+CD4+/CD4+ Ratio to Differentiate Sarcoidosis from Other Causes of Lymphocytic Alveolitis

Bretagne

Diatta²,

Faouzi³

et al. 2016

Respiration

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Role of the Lymphocyte Profile in Mediastinal Lymph Nodes in the Differential Diagnosis of Sarcoidosis and Tuberculous Lymphadenitis Patients Undergoing EBUS‐TBNA

Mi,

Cui,

Wang

et al. 2024

Diagnostic Cytopathology

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BackgroundThe value of lymphocyte profiling (LP) in mediastinal lymph nodes for the differential diagnosis of sarcoidosis has not been extensively studied, and existing literature presents mixed results.MethodsThis was a prospective study of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA). LP in lymph node puncture fluid (LNPF) was evaluated using flow cytometry. The results of LP in sarcoidosis patients were compared with tuberculous lymphadenitis (TBLA) patients. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut‐offs of the statistically significant parameters for screening for sarcoidosis. Based on the optimal cut‐offs and the final diagnosis of sarcoidosis and TBLA, the sensitivity, specificity, and accuracy of every statistically significant parameter and different combinations of the above three parameters were calculated for the diagnosis of sarcoidosis.ResultsForty‐five cases of sarcoidosis and 33 cases of TBLA were enrolled in this study. Compared with the LP in TBLA patients, in sarcoidosis patients, the proportion of CD4 T cells and CD4/CD8 ratio increased, and the proportion of CD8 T cells and natural killer (NK) cells decreased. Among all single parameters, the CD4/CD8 ratio had high diagnostic sensitivity (84.4%), specificity (81.8%), and accuracy (83.3%) for sarcoidosis. Among all the combinations of three parameters, the combination of CD4, CD8, and NKT/NK ratio had high diagnostic sensitivity (91.1%), specificity (84.8%), and accuracy (87.2%) for sarcoidosis.ConclusionsAssessment of LP in LNPF may improve the differential diagnostic accuracy of sarcoidosis from TBLA and further strengthen the importance of LP in LNPF in the diagnostic workup of sarcoidosis.

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Systemic Manifestations of Sarcoidosis

Foster

Belotto

Alvarez-Nóvoa

2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

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Value of s-ACE, BAL lymphocytosis, and CD4+/CD8+ and CD103+CD4+/CD4+ T-cell ratios in diagnosis of sarcoidosis

Cited by 30 publications

References 8 publications

Diagnostic Value of the CD103+CD4+/CD4+ Ratio to Differentiate Sarcoidosis from Other Causes of Lymphocytic Alveolitis

Diagnostic Value of the CD103+CD4+/CD4+ Ratio to Differentiate Sarcoidosis from Other Causes of Lymphocytic Alveolitis

Role of the Lymphocyte Profile in Mediastinal Lymph Nodes in the Differential Diagnosis of Sarcoidosis and Tuberculous Lymphadenitis Patients Undergoing EBUS‐TBNA

Systemic Manifestations of Sarcoidosis

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