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

Elliott D. Crouser, Lisa A. Maier, Robert P. Baughman, Eric Abston, Richard C. Bernstein, Ron Blankstein, Catherine A. Bonham, Edward S. Chen, Daniel A. Culver, Wonder Drake, Marjolein Drent, Alicia K. Gerke, Michael Ghobrial, Praveen Govender, Nabeel Hamzeh, W. Ennis James, Marc A. Judson, Liz Kellermeyer, Shandra Knight, Laura L. KothAdam S. Morgenthau, Karen C. Patterson, Venerino Poletti, Subha V. Raman, Melissa H. Tukey, Gloria E. Westney, Kevin C. Wilson

Research output: Contribution to journalReview articlepeer-review

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 (US)
Pages (from-to)E26-E51
JournalAmerican journal of respiratory and critical care medicine
Volume201
Issue number8
DOIs
StatePublished - Apr 15 2020

Keywords

  • Cardiac sarcoidosis
  • Endobronchial ultrasound biopsy
  • Granuloma
  • Pulmonary hypertension
  • Rare lung disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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