Clinical approach to pulmonary sarcoidosis

Introduction: Currently there is no consensus on the diagnostic criteria, treatment and follow-up in Pulmonary Sarcoidosis (SP). The purpose of the study was to identify a valid process for the diagnosis of SP. Method: Clinical,radiological and FOB data were collected retrospectively in 31 patients (18 F, mean age 57.3) with SP during five years.All patients performed spirometry with plethysmography and DLCO,SpO2, 6MWT and HR chest CT scans, evaluated by two radiologists with high experience in the diagnosis of interstitial lung disease.All patients underwent FOB with BALF (n = 31), TBB(n= 13) and TBNA(n = 4). In the ill-defined cases, the lymph node biopsy (n = 3) or pulmonary VATS (n = 2), have allowed definitive diagnosis. Results: The cytohistological diagnosis was made in 58% using FOB. In patients who did not undergo node biopsy or VATS, the diagnosis was made by association of BALF, HRCT scan and the exclusion of other diseases. The cut-off value of CD4/CD8 ratio for sarcoidosis was determined at 2.16 and shows a 92.4% sensitivity (95% CI, 61.5 to 98.6%) and specificity of 86.2% (96% CI, 72.1 to 92.5%). The severity of interstitial damage at CT scan and the GGO are correlated with the decline in DLCO and PaO2 / FiO2. Conclusion: Our data show that a) the clinical-radiological approach is crucial to address the diagnostic process,b) the use of appropriate endoscopic techniques are still essential for a diagnostic confirmation c) the multidisciplinary approach, the background and clinical experience, are the key for the identification of patients with pulmonary sarcoidosis when there is suspicion of a granulomatous disease. Meyer KC at al. Am J Respir Crit Care Med 2012;185:1004-14.