Rasmussen S M, Neukirch F
Acta Med Scand. 1976;199(3):209-16.
In a 10-year review of the records of 146 young male patients suspected of sarcoidosis on the basis of radiographic intrathoracic changes, the chest X-ray findings have been analysed in relation to the results of different biopsies. Most of the patients were military men, and almost all were apparently affected by the disease. Sixty-six per cent had bilateral hilar lymphadenopathy (BHL) only, 12% had isolated pulmonary lesions and 22% had both BHL and pulmonary lesions. In all patients at least one biopsy was performed, in most cases a scalene fat pad biopsy and/or a liver biopsy. Epitheloid cell granulomas were demonstrated in 86 biopsies from 64 of the 146 patients. Granulomas were obtained more frequently by scalene fat pad biopsies than by liver biopsies in the same group of patients. During the first 4--5 years of the 10-year period the scalene fat pad biopsies were done in local anesthesia in different general surgical departments without special experience of this biopsy procedure. In the last 5--6 years the scalene fat pad biopsies were done in general anaesthesia in a head and neck surgical department specially trained in this biopsy technique. Granulomas were obtained more frequently in the latter than in the former group. The highest frequency of granulomas was found among patients with both BHL and pulmonary lesions. Of the 71 patients in whom liver biopsy was performed, 43% had granulomas in the liver. A few patients had signs--although only slight--of liver affection. The results of the different biopsies are discussed in relation to the clinical picture. It is concluded that scalene fat pad biopsy in some cases can still be of some diagnostic aid in patients with radiographic intrathoracic changes suspected of sarcoidosis, although this type of biopsy has to a great extent been replaced by biopsy through mediastinoscopy. Furthermore it is concluded that comparison of different biopsies in one and the same patient could elucidate a possible relationship between the radiographic intrathoracic manifestations and the occurrence of granulomas in different intra- and extra-thoracic tissues. In this study there were only few and insignificant complications of the biopsies.
在一项为期10年的回顾性研究中，对146例因胸部影像学改变而疑似结节病的年轻男性患者的病历进行了分析，将胸部X线检查结果与不同活检结果进行了关联分析。大多数患者为军人，几乎所有患者都明显患有该病。66%的患者仅出现双侧肺门淋巴结肿大（BHL），12%的患者有孤立性肺部病变，22%的患者既有BHL又有肺部病变。所有患者均至少进行了一次活检，大多数情况下进行了斜角肌脂肪垫活检和/或肝脏活检。146例患者中的64例进行了86次活检，结果显示有上皮样细胞肉芽肿。在同一组患者中，通过斜角肌脂肪垫活检获得肉芽肿的频率高于肝脏活检。在这10年的前4至5年期间，斜角肌脂肪垫活检是在不同的普通外科科室采用局部麻醉进行的，这些科室对这种活检方法没有特殊经验。在最后5至6年期间，斜角肌脂肪垫活检是在一个专门接受过这种活检技术培训的头颈外科科室采用全身麻醉进行的。在后一组中获得肉芽肿的频率高于前一组。肉芽肿出现频率最高的是既有BHL又有肺部病变的患者。在进行肝脏活检的71例患者中，43%的患者肝脏中有肉芽肿。少数患者有肝脏受累的迹象——尽管很轻微。结合临床表现对不同活检结果进行了讨论。得出的结论是，对于胸部影像学改变疑似结节病的患者，尽管这种活检方式在很大程度上已被经纵隔镜活检所取代，但在某些情况下，斜角肌脂肪垫活检仍可能具有一定的诊断帮助。此外，得出的结论是，对同一患者不同活检结果进行比较可以阐明胸部影像学表现与不同胸内和胸外组织中肉芽肿发生之间可能存在的关系。在本研究中，活检的并发症很少且不严重。
