The Value Of Clinical Diagnostic Methods In Pulmonary Sarcoidosis

Objective: To analyze the utilization of various diagnostic methods in a group of patients with pulmonary sarcoidosis.To analyze the positive rate of diagnosis of sarcoidosis by singular or combining imaging and the bronchoscopy.To analyze the relationship between the stage of pulmonary sarcoidosis and the positive rate of the various diagnostic methods.To explore how to improve the positive rate of clinical diagnosis in pulmonary sarcoidosis.Methods: From January 2011 to December 2016,179 patients with firstly diagnosis of pulmonary sarcoidosis were prospectively enrolled the study during the hospitalization at the Department of Respiratory and Critical Care Medicine of Beijing Chao-Yang Hospital.Collecting the basic information,imaging,bronchoscopy,lung biopsy,peripheral biopsy.Retrospective analysis of the positive rate of various diagnostic methods andthe correlation with pulmonary staging,and analyzethe positive rate of singular or combining various diagnostic methods.Results: 1.There were 75 cases of chest X-ray,12.0%(9/75)diagnosed with pulmonary sarcoidosis.151 cases of chest CT scans and 62.9%(95/151)were diagnosed as pulmonary sarcoidosis,among them,41 cases of thoracic plain CT and 34.1%(14/41)were diagnosed as pulmonary sarcoidosis;59 cases of HRCT and 61.0%(36/59)diagnosed with pulmonary sarcoidosis;68 cases of chest enhanced CT,75.0%(51/68)diagnosed with pulmonary sarcoidosis.10 cases of PET-CT,50%(5/10)diagnosed with pulmonary sarcoidosis.2.Chest X-ray on the diagnosis of pulmonary sarcoidosis in the lowest positive rate.The diagnostic rate of thoracic plain CT is lower than the HRCT,chest enhanced CT,and PET-CT.There were no significant differences in diagnostic rate of HRCT,chest enhanced CT and PET-CT.3.29.4%(32/109)with lymphocyte proportion increased and CD4 /CD8> 3.5 in patient's BALF diagnosed as sarcoidosis;37.2%(58/156)in EBB patients diagnosed as sarcoidosis,60.5%(75/124)in TBLB diagnosed as sarcoidosis;78.6%(70/89)in EBUS-TBNA diagnosed as sarcoidosis.4.There were 38 patients whose bronchoscopic change show bronchial nodules had treated with EBB,73.7%(28/38)were diagnosed as sarcoidosis,showed a significant increase than whose airway without nodules.5.There was no statistically significant difference in the diagnosis of pulmonary sarcoidosis by TBLB in patients under different bronchoscopic image.Whose bronchoscopic change show bronchial nodules prefer to EBB than TBLB.6.EBB had no significant difference in the positive rate of different pulmonary stage.7.TBLB on stage II and stage III pulmonary sarcoidosis diagnosis rate is higher than the diagnosis of stage I.8.EBUS-TBNA diagnosis of stage I pulmonary sarcoidosis is higher than the diagnosis of stage II and stage III pulmonary sarcoidosis.9.As for stage 0 and stage I or stage II pulmonary sarcoidosis,there was no statistically significant difference in the diagnostic rate of pulmonary sarcoidosis by TBLB or EBUS-TBNA.10.There was no significant difference in the diagnostic rate of EBUS-TBNA to EBUS-TBNA combined with other bronchoscopy examinations in the diagnosis of pulmonary sarcoidosis,EBUS-TBNA play an important role in diagnose pulmonary sarcoidosis.11.HRCT combined with TBLB,HRCT combined with EBUS-TBNA could improve the diagnostic rate of HRCT on pulmonary sarcoidosis.HRCT combined with EBB,HRCT combined with CD4 / CD8 could not improve the diagnostic rate of HRCT in pulmonary sarcoidosis.12.Enhanced chest CT combined with EBUS-TBNA could improve the diagnostic rate of enhanced chest CT in the diagnosis of pulmonary sarcoidosis.Enhanced chest CT combined with other bronchoscopy examination(including lymphocyte proportion increased and CD4 /CD8> 3.5 in BALF,EBB,TBLB)could not improve the diagnostic rate of enhanced chest CT in pulmonary sarcoidosis.Conclusions:1.For pulmonary sarcoidosis,imaging examination preferred HRCT or chest enhanced CT.2.When the bronchoscope showed airway nodules change,then preferred EBB3.Suspected patients with stage I sarcoidosis,fist choice is EBUS-TBNA.4.Suspected stage II or stage III pulmonary sarcoidosis,preferred of TBLB or EBUSTBNA.5.In the diagnosis of pulmonary sarcoidosis,EBUS-TBNA has the highest diagnostic value.6.When HRCT or chest enhanced CT finished,we would better not singular to the BAL or singular in EBB,we would conduct other biopsy.