From the Guidelines
The diagnostic workup for sarcoidosis should include a comprehensive clinical assessment, targeted laboratory tests, imaging studies, and potentially a biopsy, as recommended by the American Thoracic Society clinical practice guideline 1. The workup should begin with a thorough history and physical examination, focusing on common symptoms like fatigue, cough, and skin lesions.
- Laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel
- Serum calcium
- Angiotensin-converting enzyme (ACE) levels
- Urinalysis for calcium excretion Chest X-ray and high-resolution CT scan of the chest are crucial imaging studies, as pulmonary involvement is common, according to the European Respiratory Journal 1.
- Pulmonary function tests, including spirometry and diffusion capacity, should be performed. Additional imaging may include cardiac MRI if cardiac sarcoidosis is suspected, as suggested by the American Thoracic Society clinical practice guideline 1. If the diagnosis remains uncertain, a biopsy of affected tissue (commonly from lung, skin, or lymph nodes) may be necessary to demonstrate non-caseating granulomas, as recommended by the American Thoracic Society clinical practice guideline 1. Bronchoscopy with transbronchial biopsy can be considered for pulmonary sarcoidosis. Specialized testing may be required based on suspected organ involvement, such as ophthalmologic examination for ocular sarcoidosis or 24-hour Holter monitoring for cardiac sarcoidosis, as mentioned in the European Respiratory Journal 1. This comprehensive approach allows for accurate diagnosis, assessment of disease extent, and guides treatment decisions, ultimately prioritizing morbidity, mortality, and quality of life as the outcome, as emphasized by the American Thoracic Society clinical practice guideline 1 and the European Respiratory Journal 1.
From the Research
Diagnostic Workup for Sarcoidosis
The diagnostic workup for sarcoidosis involves several steps, including:
- Confirming the diagnosis and assessing organ involvement/impairment 2
- Identifying manifestations linked to sarcoidosis at diagnosis work-up and during evolution 3
- Recognizing "danger" in sarcoidosis and parasarcoidosis syndromes 3
- Diagnosing sarcoidosis recovery 3
Diagnostic Criteria
The diagnosis of sarcoidosis is based on three criteria:
- A compatible presentation 3, 4
- Evidence of non-caseating granulomas 3, 4, 5
- Exclusion of any alternative diagnosis 3, 4
Diagnostic Assessment
The diagnostic assessment for sarcoidosis may include:
- Superficial biopsies of clinically suspected lesions 3
- Bronchial endoscopy 3
- High-resolution computed tomography 5
- Magnetic resonance imaging 5
- 18F-fluorodeoxyglucose positron emission tomography 5
- Electrocardiogram and blood biology 3
Organ Involvement
Affected organs need to be related to sarcoidosis using an appropriate diagnostic assessment instrument 3. The most common organs involved in sarcoidosis include: