Bradley J Petek1, David G Rosenthal2, Kristen K Patton3, Sanaz Behnia4, Jonathan M Keller5, Bridget F Collins5, Richard K Cheng3, Lawrence A Ho5, Paco E Bravo6, Carmen Mikacenic7, Ganesh Raghu5. 1. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 2. Division of Cardiology, University of California San Francisco, San Francisco, CA, USA. 3. Division of Cardiology, University of Washington, Seattle, WA, USA. 4. Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA, USA. 5. Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA. 6. Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA. 7. Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA. Electronic address: cmikacen@uw.edu.
Abstract
INTRODUCTION: The diagnosis of cardiac sarcoidosis (CS) is difficult to ascertain due to the insensitivity of endomyocardial biopsy. Current diagnostic criteria require a positive endomyocardial biopsy or extra-cardiac biopsy with clinical features suggestive of CS. Common tests for diagnosis of pulmonary sarcoidosis include bronchoalveolar lavage (BAL), lung and mediastinal lymph node (MLN) biopsies. Our objective was to determine the diagnostic utility of these tests in patients with suspected CS and without prior history of pulmonary involvement. METHODS: This retrospective cohort study included 37 patients without history of extra-cardiac sarcoidosis referred for suspected CS. All patients underwent chest computed tomography (CT) staged using the modified Scadding criteria, and had BAL, and/or lung or MLN biopsy. BAL cellular analyses with lymphocytes>15% and/or CD4/CD8 ratio≥ 4 were considered suggestive of sarcoidosis. The number of positive biopsies and BALs were compared between normal CT (Scadding stage 0) and abnormal CT (Scadding stage 1-4) groups. RESULTS: A definitive diagnosis of sarcoidosis was ascertained in 18/31 (58%) patients undergoing lung or lymph node biopsy, and a potential diagnosis in 18/27 (67%) patients with BAL CD4/CD8>4 or lymphocytes>15%. Of the 12 patients in the normal CT group, 4/10 (40%) had positive lung biopsies, and 9/12 (75%) patients had either positive biopsy or BAL criteria. CONCLUSIONS: In suspected cardiac sarcoidosis, a diagnosis of extra-cardiac sarcoidosis was ascertained in a majority of patients irrespective of degree of lung involvement on chest CT. Our results support referral for pulmonary biopsy/bronchoalveolar lavage in suspected CS to confirm the diagnosis of sarcoidosis.
INTRODUCTION: The diagnosis of cardiac sarcoidosis (CS) is difficult to ascertain due to the insensitivity of endomyocardial biopsy. Current diagnostic criteria require a positive endomyocardial biopsy or extra-cardiac biopsy with clinical features suggestive of CS. Common tests for diagnosis of pulmonary sarcoidosis include bronchoalveolar lavage (BAL), lung and mediastinal lymph node (MLN) biopsies. Our objective was to determine the diagnostic utility of these tests in patients with suspected CS and without prior history of pulmonary involvement. METHODS: This retrospective cohort study included 37 patients without history of extra-cardiac sarcoidosis referred for suspected CS. All patients underwent chest computed tomography (CT) staged using the modified Scadding criteria, and had BAL, and/or lung or MLN biopsy. BAL cellular analyses with lymphocytes>15% and/or CD4/CD8 ratio≥ 4 were considered suggestive of sarcoidosis. The number of positive biopsies and BALs were compared between normal CT (Scadding stage 0) and abnormal CT (Scadding stage 1-4) groups. RESULTS: A definitive diagnosis of sarcoidosis was ascertained in 18/31 (58%) patients undergoing lung or lymph node biopsy, and a potential diagnosis in 18/27 (67%) patients with BAL CD4/CD8>4 or lymphocytes>15%. Of the 12 patients in the normal CT group, 4/10 (40%) had positive lung biopsies, and 9/12 (75%) patients had either positive biopsy or BAL criteria. CONCLUSIONS: In suspected cardiac sarcoidosis, a diagnosis of extra-cardiac sarcoidosis was ascertained in a majority of patients irrespective of degree of lung involvement on chest CT. Our results support referral for pulmonary biopsy/bronchoalveolar lavage in suspected CS to confirm the diagnosis of sarcoidosis.
Authors: Nouf A Mushari; Georgios Soultanidis; Lisa Duff; Maria G Trivieri; Zahi A Fayad; Philip Robson; Charalampos Tsoumpas Journal: Front Med (Lausanne) Date: 2022-02-28
Authors: Jarieke C Hoogendoorn; Maarten K Ninaber; Sebastiaan R D Piers; Marta de Riva; Robert W Grauss; Frank M Bogun; Katja Zeppenfeld Journal: Europace Date: 2020-09-01 Impact factor: 5.214