Sakamoto Noritaka, Sawahata Michiru, Yamanouchi Yoshitaka, Konno Satoshi, Shijubo Noriharu, Yamaguchi Tetsuo, Nakamura Yosikazu, Suzuki Takuji, Hagiwara Koichi, Bando Masashi
Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan.
Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan.
J Rural Med. 2021 Apr;16(2):77-82. doi: 10.2185/jrm.2020-022. Epub 2021 Apr 1.
Histological verification of epithelioid cell granuloma is important in diagnosing sarcoidosis; tissue sampling is a worldwide requirement. In 2006, to reduce medical expenses and avoid invasive procedures, diagnostic criteria without histological verification were permitted by the Japanese government. In 2015, new diagnostic criteria, allowed clinical diagnoses based on only respiratory, ocular, and cardiac systems with at least a two-system involvement, increasing the need to sample tissue from clinically unevaluable organs in suspected sarcoidosis. This study aimed to compare the characteristics of patients who were diagnosed with sarcoidosis according to the 2006 and 2015 criteria. Using the 2015 version, we re-evaluated the characteristics of 264 patients with diagnosed or suspected sarcoidosis according to the 2006 criteria, at Jichi Medical University Hospital between 2004 and 2012 (clinical diagnosis, 84; histological diagnosis, 117; suspected sarcoidosis 63). Thirty-nine patients were diagnosed with suspected sarcoidosis due to the absence of at least a two-system involvement; two patients had insufficient laboratory data suggestive of sarcoidosis. Six patients moved from suspected sarcoidosis to a histological diagnosis because of a greater leniency in the criteria for supportive findings. The 2015 diagnostic criteria excluded patients with organ involvement without a requirement for systemic steroids from the clinical diagnosis group. A case of schwannoma, erroneously placed in the clinical diagnosis group by the 2006 criteria, was reclassified according to the 2015 criteria. The 2015 version is preferable for clinically diagnosing sarcoidosis, even without histological specimens, and provides guidance for indications for systemic treatment.
上皮样细胞肉芽肿的组织学验证对结节病的诊断很重要；组织取样是全球的要求。2006年，为了降低医疗费用并避免侵入性操作，日本政府允许了无需组织学验证的诊断标准。2015年，新的诊断标准允许仅基于呼吸、眼和心脏系统且至少累及两个系统的临床诊断，这增加了对疑似结节病患者中临床无法评估器官进行组织取样的需求。本研究旨在比较根据2006年和2015年标准诊断为结节病的患者的特征。使用2015年版本，我们重新评估了2004年至2012年期间在筑波大学医学部附属医院根据2006年标准诊断或疑似结节病的264例患者的特征（临床诊断84例；组织学诊断117例；疑似结节病63例）。39例患者因未至少累及两个系统而被诊断为疑似结节病；2例患者提示结节病的实验室数据不足。6例患者因支持性发现标准放宽而从疑似结节病转为组织学诊断。2015年诊断标准将无需全身用类固醇治疗的器官受累患者从临床诊断组中排除。1例根据2006年标准错误地归入临床诊断组的神经鞘瘤病例，根据2015年标准重新分类。2015年版本即使在没有组织学标本的情况下也更适合结节病的临床诊断，并为全身治疗的指征提供指导。
