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Key Points
➤ The diagnosis of sarcoidosis is not standardized but is based on three
major criteria:
• a compatible clinical presentation
• finding nonnecrotizing granulomatous inflammation in one or more tissue
samples
• the exclusion of alternative causes of granulomatous disease.
Diagnosis
Lymph Node Sampling
➤ In patients for whom there is a high clinical suspicion for sarcoidosis
(e.g., Löfgren's syndrome, lupus pernio, or Heerfordt's syndrome),
the ATS suggests NOT sampling lymph nodes (conditional
recommendation, very low-quality evidence).
Remarks: Patients who do not undergo lymph node sampling require close clinical
follow-up.
➤ For patients presenting with asymptomatic, bilateral hilar
lymphadenopathy, the ATS makes no recommendations for or against
obtaining a lymph node sample.
Remarks: If lymph node sampling is not obtained, close clinical follow-up is a reasonable
alternative approach.
➤ For patients with suspected sarcoidosis and mediastinal and/or
hilar lymphadenopathy for whom it has been determined that tissue
sampling is necessary, the ATS suggests endobronchial ultrasound
(EBUS)-guided lymph node sampling, rather than mediastinoscopy, as
the initial mediastinal and/or hilar lymph node sampling procedure
(conditional recommendation, very low-quality evidence).
