Diagnosis and Detection of Sarcoidosis An Official American Thoracic Society Clinical Practice Guideline

E.D. Crouser*, L.A. Maier, K.C. Wilson, C.A. Bonham, A.S. Morgenthau, K.C. Patterson, E. Abston, R.C. Bernstein, R. Blankstein, E.S. Chen, D.A. Culver, W. Drake, M. Drent, A.K. Gerke, M. Ghobrial, P. Govender, N. Hamzeh, W.E. James, M.A. Judson, L. KellermeyerS. Knight, L.L. Koth, V. Poletti, S.V. Raman, M.H. Tukey, G.E. Westney, R.P. Baughman, American Thoracic Society Assembly on Clinical Problems

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

182 Citations (Web of Science)

Abstract

Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability.Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality.Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
Original languageEnglish
Pages (from-to)E26-E51
Number of pages26
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume201
Issue number8
DOIs
Publication statusPublished - 15 Apr 2020

Keywords

  • cardiac involvement
  • cardiac sarcoidosis
  • endobronchial ultrasound
  • endobronchial ultrasound biopsy
  • granuloma
  • late gadolinium enhancement
  • ocular sarcoidosis
  • positron-emission-tomography
  • pulmonary hypertension
  • pulmonary-hypertension
  • rare lung disease
  • renal sarcoidosis
  • suspected stage-i
  • transbronchial needle aspiration
  • vitamin-d
  • VITAMIN-D
  • TRANSBRONCHIAL NEEDLE ASPIRATION
  • ENDOBRONCHIAL ULTRASOUND
  • PULMONARY-HYPERTENSION
  • OCULAR SARCOIDOSIS
  • SUSPECTED STAGE-I
  • LATE GADOLINIUM ENHANCEMENT
  • CARDIAC INVOLVEMENT
  • POSITRON-EMISSION-TOMOGRAPHY
  • RENAL SARCOIDOSIS

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