Munkgaard S, Neukirch F
Acta Med Scand. 1979;205(3):179-84. doi: 10.1111/j.0954-6820.1979.tb06027.x.
A series of 78 patients, mainly young males, with intrathoracic manifestations of sarcoidosis, found on routine chest X-ray, were examined according to a prescheduled program including different biopsy procedures. In 76% the intrathoracic changes were isolated hilar adenopathy, in 9% isolated pulmonary lesions and in 15% hilar adenopathy plus pulmonary lesions. Lymph nodes containing granulomas were found by mediastinoscopy in 41 of 44 patients and by scalene fat pad biopsy in 20 of 34 patients. In 27 of 76 patients granulomas were found by liver biopsy. Complications to the biopsies were more frequent with mediastinoscopy than with the other two biopsy procedures, but no serious complications occurred. Biopsy through mediastinoscopy is thus preferable in patients of this kind. The necessity of doing biopsies to support the diagnosis of sarcoidosis is discussed on the basis of the literature and our own studies. In younger patients with asymptomatic, bilateral hilar adenopathy without pulmonary lesions it seems justifiable to omit biopsy, whereas biopsy is mandatory in patients with unilateral hilar lymph adenopathy and patients with pulmonary lesions. In all cases the course of the disease should be followed for a rather long period.
78例主要为年轻男性的患者，在常规胸部X线检查时发现有结节病的胸内表现，按照预定方案进行了检查，包括不同的活检程序。76%的患者胸内改变为单纯肺门淋巴结肿大，9%为单纯肺部病变，15%为肺门淋巴结肿大合并肺部病变。44例患者中41例通过纵隔镜检查发现含肉芽肿的淋巴结，34例患者中20例通过斜角肌脂肪垫活检发现。76例患者中27例通过肝活检发现肉芽肿。纵隔镜检查活检的并发症比其他两种活检程序更常见，但未发生严重并发症。因此，对于这类患者，纵隔镜活检更可取。基于文献和我们自己的研究，讨论了进行活检以支持结节病诊断的必要性。对于无症状的双侧肺门淋巴结肿大且无肺部病变的年轻患者，省略活检似乎是合理的，而对于单侧肺门淋巴结肿大的患者和有肺部病变的患者，活检是必需的。在所有病例中，都应长期随访疾病的病程。
