The Definitive Evaluation of Sarcoidosis1, 2

Thirty patients with clinical, roentgenographic, and histologic manifestations of sarcoidosis on biopsy of peripheral tissues were subjected to exhaustive diagnostic study in an attempt to establish a definitive diagnosis other than sarcoidosis. This was accomplished in 27 patients. The most rewarding diagnostic procedure was open lung biopsy, which proved to be the definitive diagnostic procedure in 16 patients. Additional diagnostic procedures included cultures of secretions and biopsied tissues, special staining techniques, chemical analysis of biopsy specimens, and immunologic studies. In the patient with suspected intrathoracic sarcoidosis, the diagnosis cannot be established without open thoracotomy unless preliminary cultures or biopsies of peripheral tissue reveal evidence of another pathologic process known to cause a granulomatous reaction. The presence of sarcoid in a patient with an abnormal chest film cannot be confirmed by scalene node biopsy, a Kveim test, or absence of bacteriologic eviden...