Culver Daniel A
Department of Pulmonary Medicine, Respiratory Institute, Cleveland, Ohio, USA.
Curr Opin Pulm Med. 2015 Sep;21(5):499-509. doi: 10.1097/MCP.0000000000000201.
The usual diagnostic criteria for sarcoidosis include the documentation of a compatible clinicoradiologic scenario, biopsy proof of granulomas, and exclusion of alternate causes for the findings. Establishing the presence of multisystem disease, and longitudinal assessment for the emergence of potential sarcoidosis mimics both strengthen the diagnosis. These principles have constituted a 'diagnostic modus operandi' for several decades, but the emergence of several new technologies has begun to transform their application.
The widespread availability of high-resolution chest computed tomography, endobronchial ultrasound-guided transbronchial needle aspiration, rapid on-site cytopathology and to a lesser degree, fluorodeoxyglucose positron emission tomography have facilitated more convenient diagnosis. They also have identified possibilities for biopsy-less diagnosis in appropriate clinical contexts, similar to idiopathic pulmonary fibrosis, and allowed for more comprehensive assessment of the extent and activity of disease. Nonetheless, these new technologies cannot replace the central role of the clinician, whose judgment and circumspection are keys to accurate diagnosis.
The diagnosis of sarcoidosis and the assessment of its extent should be tailored to the clinical situation. The application of new technologies may permit some evolution of the diagnostic approach in many patients.
结节病的常规诊断标准包括记录相符的临床放射学表现、肉芽肿的活检证据以及排除其他导致这些表现的病因。确定多系统疾病的存在以及对潜在结节病模仿症出现情况的纵向评估均有助于强化诊断。几十年来，这些原则构成了一种“诊断操作方法”，但多种新技术的出现已开始改变其应用方式。
高分辨率胸部计算机断层扫描、支气管内超声引导下经支气管针吸活检、快速现场细胞病理学以及程度稍轻的氟脱氧葡萄糖正电子发射断层扫描的广泛应用使诊断更加便捷。它们还在适当的临床情况下确定了无需活检即可诊断的可能性，类似于特发性肺纤维化，并能对疾病的范围和活动进行更全面的评估。尽管如此，这些新技术无法取代临床医生的核心作用，临床医生的判断和审慎是准确诊断的关键。
结节病的诊断及其范围评估应根据临床情况进行调整。新技术的应用可能会使许多患者的诊断方法有所改进。
