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Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. 2020
Elliott D Crouser, and
Lisa A Maier, and
Kevin C Wilson, and
Catherine A Bonham, and
Adam S Morgenthau, and
Karen C Patterson, and
Eric Abston, and
Richard C Bernstein, and
Ron Blankstein, and
Edward S Chen, and
Daniel A Culver, and
Wonder Drake, and
Marjolein Drent, and
Alicia K Gerke, and
Michael Ghobrial, and
Praveen Govender, and
Nabeel Hamzeh, and
W Ennis James, and
Marc A Judson, and
Liz Kellermeyer, and
Shandra Knight, and
Laura L Koth, and
Venerino Poletti, and
Subha V Raman, and
Melissa H Tukey, and
Gloria E Westney, and
Robert P Baughman
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.
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