ATS GUIDELINES Bundle

Sarcoidosis

American Thoracic Society Quick-Reference GUIDELINES Apps

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2 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).

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