Cardiac sarcoidosis: Diagnosis confirmation by bronchoalveolar lavage and lung biopsy. (November 2018)

• Record Type: Journal Article
• Authors: Petek, Bradley J.; Rosenthal, David G.; Patton, Kristen K.; Behnia, Sanaz; Keller, Jonathan M.; Collins, Bridget F.; Cheng, Richard K.; Ho, Lawrence A.; Bravo, Paco E.; Mikacenic, Carmen; Raghu, Ganesh
• Is Part Of: Respiratory medicine. Volume 144(2018)Supplement
• Page Start: S13
• Page End: S19
• Publication Date: 2018-11
• Subjects: Sarcoidosis -- Bronchoalveolar lavage -- Bronchoscopy -- Lung biopsy -- Computed tomography; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2018.09.008
• Languages: English
• ISSNs: 0954-6111

Abstract

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. Highlights: Bronchoscopy is informative in patients with suspected cardiac sarcoidosis. Bronchoalveolar lavage cellular analyses assist in diagnosis of cardiac sarcoidosis. Diagnosis by tranbronchial lung biopsy can occur with limited lung involvement.