Desai Sujal R, Sivarasan Nishanth, Johannson Kerri A, George Peter M, Culver Daniel A, Devaraj Anand, Lynch David A, Milne David, Renzoni Elisabetta, Nunes Hilario, Sverzellati Nicola, Spagnolo Paolo, Baughman Robert P, Yadav Ruchi, Piciucchi Sara, Walsh Simon L F, Kouranos Vasileios, Wells Athol U
Department of Radiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK.
Department of Radiology, Royal Brompton Hospital, London, UK.
Lancet Respir Med. 2024 May;12(5):409-418. doi: 10.1016/S2213-2600(23)00267-9. Epub 2023 Dec 14.
One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis.
一种关于结节病的观点认为，该术语涵盖了许多不同的疾病。然而，目前尚无分类框架用于未来对致病途径、遗传倾向或触发因素偏好、肺功能损害模式、治疗差异的探索，也无法用于开发诊断算法或相关的预后指标。我们旨在通过多轮跨国德尔菲共识过程，就结节病的高分辨率CT（HRCT）表型分类达成一致，为未来的CT研究提供基础。德尔菲参与者包括弗莱施纳学会和结节病及其他肉芽肿性疾病世界协会的成员，以及成员提名的人员。来自28个国家的146人（98名胸科医生、48名胸放射科医生）参与其中，144人完成了两轮德尔菲调查。在对35条德尔菲陈述进行五分制李克特量表评分后，22条（63%）陈述达成了共识。对于不同HRCT表型的存在，达成了97%的共识，参与者将7种HRCT表型归类为非纤维化或可能纤维化。此次德尔菲活动达成的国际共识证明了制定CT分类作为可能定义不同疾病基础的合理性。现在需要通过快速可行的CT研究进一步细化表型，以支持结节病正式分类的制定。
