Millward Kate, Fiddler Christine A, Thillai Muhunthan
Respiratory Sleep and Support Centre, Royal Papworth Hospital.
Cambridge Interstitial Lung Disease Service, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus.
Curr Opin Pulm Med. 2021 Sep 1;27(5):484-489. doi: 10.1097/MCP.0000000000000807.
The current review summarizes recent guidance in the diagnosis and management of sarcoidosis. Until recently, the main guidelines were the 1999 International Statement on Sarcoidosis. However, in 2020 two new guidelines were published by the American and British Thoracic Societies. They have a number of key updates and this review aims to summarize these.
The key findings from 2020 revolve around several themes. First, the need for a histological diagnosis should be supported by a multidisciplinary team approach. When a histological biopsy is needed of the lungs, thought is given to the approach taken for this and to whether an endobronchial ultrasound, endoscopic ultrasound or transbronchial biopsy is needed. Second, information regarding supporting tests including blood biomarkers, lung function and imaging. Third, a section specific to cardiac sarcoidosis. Finally, a summary of guidance for treating sarcoidosis including the need to treat fatigue.
The recent guidance suggests that a histological biopsy is only needed in cases of diagnostic uncertainty or in patients with typical long standing features on imaging. The guidelines also provide a clear pathway on the type of lung biopsy needed depending on the extent of mediastinal or parenchymal involvement. Support is given to steroid regimens and indication for second-line immunosuppression.
本综述总结了结节病诊断和管理方面的最新指南。直到最近，主要指南还是1999年的《结节病国际声明》。然而，2020年美国和英国胸科学会发布了两项新指南。它们有一些关键更新，本综述旨在对此进行总结。
2020年的关键发现围绕几个主题展开。首先，组织学诊断的必要性应由多学科团队方法来支持。当需要对肺部进行组织学活检时，要考虑采取的方法以及是否需要支气管内超声、内镜超声或经支气管活检。其次，关于辅助检查的信息，包括血液生物标志物、肺功能和影像学检查。第三，有一个关于心脏结节病的特定章节。最后，总结了结节病治疗指南，包括治疗疲劳的必要性。
最新指南表明，仅在诊断存在不确定性的病例或影像学上有典型长期特征的患者中需要进行组织学活检。指南还根据纵隔或实质受累程度，就所需的肺活检类型提供了明确的路径。支持使用类固醇方案以及二线免疫抑制的指征。
