Ways to Enhance the Diagnosis of Pulmonary Sarcoidosis (Literature Review)
https://doi.org/10.58838/2075-1230-2025-103-2-102-110
Abstract
The article analyzes 50 publications devoted to diagnostic approaches to detection of sarcoidosis. It highlights that currently diagnosis of this disease is not standardized and thus errors are highly possible to occur. Improved approaches address all aspects of diagnosis, from the distinction of highly specific clinical and radiologic signs of the disease to the choice of lung biopsy method. The use of sarcoidosis biomarkers such as angiotensin-converting enzyme, chitotriosidase, and serum amyloid A is most promising. The possibility of their combination and association with clinical signs of the disease are being studied, and to discover new biomarkers, full-genome studies are being in progress.
About the Authors
Yu. S. ZinchenkoRussian Federation
Yulia S. Zinchenko - Candidate of Medical Sciences, Senior Researcher, Head of Research Laboratory of Non-Specific Lung Diseases
2-4 Ligovsky Ave., St. Petersburg, 191036
Phone: +7 (812) 775-75-50
V. O. Polyakova
Russian Federation
Viktoria O. Polyakova - Doctor of Biological Sciences, Professor, Deputy Director
2-4 Ligovsky Ave., St. Petersburg, 191036
Phone: +7 (812) 775-75-50
A. N. Muraviev
Russian Federation
Aleksandr N. Muraviev - Candidate of Medical Sciences, Leading Researcher, Head of Research Laboratory of Cellular Biology and Regenerative Medicine, Academic Secretary
2-4 Ligovsky Ave., St. Petersburg, 191036
Phone: +7 (812) 775-75-50
I. R. Tubeeva
Russian Federation
Ilona R. Tubeeva - Resident Physician
2-4 Ligovsky Ave., St. Petersburg, 191036
Phone: +7 (812) 775-75-50
S. V. Starevskaya
Russian Federation
Svetlana V. Starevskaya Doctor of Medical Sciences, Leading Researcher, Head of Pediatric Pulmonology Unit, Associate Professor of Pediatrics and Pediatric Cardiology Department, North-Western State Medical University named after I.I.Mechnikov
2-4 Ligovsky Ave., St. Petersburg, 191036
Phone: +7 (812) 775-75-50
P. K. Yablonskiy
Russian Federation
Petr K. Yablonskiy - Doctor of Medical Sciences, Professor, Director, Head of Hospital Surgery Department of Medical Faculty of St. Petersburg University
2-4 Ligovsky Ave., St. Petersburg, 191036
Phone: +7 (812) 775-75-50
References
1. Belyaev G.S., Vasiliev I.V., Mamenko I.S., Tabanakova I.A., Novitskaya T.A., Yablonskiy P.K. Comparison of the efficacy of transbronchial cryobiopsy with transbronchial forceps biopsy in the diagnosis of diffuse parenchymal lung diseases. Meditsinsky Alyans, 2022, vol. 10, no. 2, pp. 40-49. (In Russ.) https://doi.org/10.36422/23076348-2022-10-2-40-49
2. Klinicheskiye rekomendatsii Sarkoidoz. [Clinical guidelines on sarcoidosis], Moscow, Russian Respiratory Society, Russian Scientific Medical Society of Physicians, Pediatric Respiratory Society, Russian Phthisiologists' Society, 2024.
3. Bargagli E., Bennett D., Maggiorelli C., Di Sipio P., Margollicci M., Bianchi N., Rottoli P. Human chitotriosidase: a sensitive biomarker of sarcoidosis // J Clin Immunol. – 2013. –Vol. 33, № 1. – P. 264-270. https://doi.org/10.1007/s10875-012-9754-4
4. Bargagli E., Magi B., Olivieri C., Bianchi N., Landi C., Rottoli P. Analysis of serum amyloid A in sarcoidosis patients // Respir Med. – 2011. – Vol. 105, № 5. – P. 775-80. https://doi.org/10.1016/j.rmed.2010.12.010
5. Bargagli E., Mazzi A., Rottoli P. Markers of Inflammation in Sarcoidosis: Blood, Urine, BAL, Sputum, and Exhaled Gas // Clinics in Chest Medicine. – 2008. – Vol. 29, № 3. – P. 445-458. https://doi.org/10.1016/j.ccm.2008.03.004
6. Baughman R., Nagai S., Balter M., Costabel U., Drent M., du Bois R., Grutters J., Judson M., Lambiri I., Lower E., Muller-Quernheim J., Prasse A., Rizzato G., Rottoli P., Spagnolo P., Teirstein A. Defining the clinical outcome status (COS) in sarcoidosis: results of WASOG Task Force // Sarcoidosis Vasc Diffuse Lung Dis. – 2011. – Vol. 28, № 1. – P. 56-64. PMID: 21796892
7. Baughman R., Scholand M., Rahaghi F. Clinical phenotyping: role in treatment decisions in sarcoidosis // Eur Respir Rev. – 2020. – Vol. 29, № 155. – P. 190145. https://doi.org/10.1183/16000617.0145-2019
8. Baughman R., Teirstein A., Judson M., Rossman M., Yeager H., Bresnitz E., DePalo L., Hunninghake G., Iannuzzi M., Johns C., McLennan G., Moller D., Newman L., Rabin D., Rose C., Rybicki B., Weinberger S., Terrin M., Knatterud G., Cherniak R. Case Control Etiologic Study of Sarcoidosis (ACCESS) research group. Clinical characteristics of patients in a case control study of sarcoidosis // Am J Respir Crit Care Med. – 2001. – Vol. 164, № 10(1). – P. 1885-1889. https://doi.org/10.1164/ajrccm.164.10.2104046
9. Benamore R., Kendrick Y., Repapi E., Helm E., Cole S., Taylor S., Ho L. CTAS: a CT score to quantify disease activity in pulmonary sarcoidosis // Thorax. – 2016. – Vol. 71, № 12. – P. 1161-1163. https://doi.org/10.1136/thoraxjnl-2016-208833
10. Bergantini L., d'Alessandro M., Vietri L., Rana G., Cameli P., Acerra S., Sestini P., Bargagli E. Utility of serological biomarker' panels for diagnostic accuracy of interstitial lung diseases // Immunol Res. – 2020. – Vol. 68, № 6. – P. 414-421. https://doi.org/10.1007/s12026-020-09158-0
11. Bernardinello N., Petrarulo S., Balestro E., Cocconcelli E., Veltkamp M., Spagnolo P. Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis // Diagnostics (Basel). – 2021. – Vol. 11, № 9. – P. 1558. https://doi.org/10.3390/diagnostics11091558
12. Bickett A., Lower E., Baughman R. Sarcoidosis Diagnostic Score: A Systematic Evaluation to Enhance the Diagnosis of Sarcoidosis // Chest. – 2018. – Vol. 154, № 5. – P. 1052-1060. https://doi.org/10.1016/j.chest.2018.05.003
13. Casanova N., Zhou T., Knox K., Garcia J. Identifying Novel Biomarkers in Sarcoidosis Using Genome-Based Approaches // Clin Chest Med. – 2015. – Vol. 36, № 4. – P. 621-630. https://doi.org/10.1016/j.ccm.2015.08.005
14. Christophi G., Caza T., Curtiss C., Gumber D., Massa P., Landas S. Gene expression profiles in granuloma tissue reveal novel diagnostic markers in sarcoidosis // Exp Mol Pathol. – 2014. – Vol. 96, № 3. – P. 393-399. https://doi.org/10.1016/j.yexmp.2014.04.006
15. Criado E., SáNchez M., RamíRez J. Arguis P., de Caralt T., Perea R., Xaubet A. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation // Radiographics. – 2010. – Vol. 30, № 6. – P. 1567-1586. https://doi.org/10.1148/rg.306105512
16. Crouser E., Culver D., Knox K., Julian M., Shao G., Abraham S., Liyanarachchi S., Macre J., Wewers M., Gavrilin M., Ross P., Abbas A., Eng C. Gene expression profiling identifies MMP-12 and ADAMDEC1 as potential pathogenic mediators of pulmonary sarcoidosis // Am J Respir Crit Care Med. – 2009. – Vol. 179, № 10. P. 929-938. https://doi.org/10.1164/rccm.200803-490OC
17. Crouser E., Maier L., Wilson K., Bonham C., Morgenthau A., Patterson K., Abston E., Bernstein R., Blankstein R., Chen E., Culver D., Drake W., Drent M., Gerke A., Ghobrial M., Govender P., Hamzeh N., James W., Judson M., Kellermeyer L., Knight S., Koth L., Poletti V., Raman S., Tukey M., Westney G., Baughman R. Diagnosis and detection of Sarcoidosis. An official American Thoracic Society clinical practice guideline // Am. J. Respir. Crit. Care Med. – 2020. – Vol. 201, № 8. – Р. e26-e51. https://doi.org/10.1164/rccm.202002-0251ST
18. Culver D., Judson M. New advances in the management of pulmonary sarcoidosis // BMJ. – 2019. – № 367. – P. l5553. https://doi.org/10.1136/bmj.l5553
19. Desai S., Sivarasan N., Johannson K., George P., Culver D., Devaraj A., Lynch D., Milne D., Renzoni E., Nunes H., Sverzellati N., Spagnolo P., Baughman R., Yadav R., Piciucchi S., Walsh S., Kouranos V., Wells A., Sarcoid Delphi Group. High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study // Lancet Respir Med. – 2024. – Vol. 12, № 5. – Р. 409-418. https://10.1016/S2213-2600(23)00267-9
20. Dhooria S., Agarwal R., Aggarwal A., Bal A., Gupta N., Gupta D. Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: A study of 165 patients // J. Thorac. Cardiovasc. Surg. – 2014. – Vol. 148, № 2. – P. 662–667. https://doi.org/10.1016/j.jtcvs.2014.01.028
21. Drent M., De Vries J., Lenters M., Lamers R., Rothkranz-Kos S., Wouters E., van Dieijen-Visser M., Verschakelen J. Sarcoidosis: assessment of disease severity using HRCT // Eur Radiol. – 2003. – Vol. 13, № 11. – P. 2462-2471. https://doi.org/10.1007/s00330-003-1965-x
22. Enyedi A., Csongrádi A., Altorjay I., Beke G, Váradi C., Enyedi E., Kiss D., Bányai E., Kalina E., Kappelmayer J., Tóth A., Papp Z., Takács I., Fagyas M. Combined application of angiotensin converting enzyme and chitotriosidase analysis improves the laboratory diagnosis of sarcoidosis // Clin Chim Acta. – 2020. – № 500. – P. 155-162. https://doi.org/10.1016/j.cca.2019.10.010
23. Eroglu S., Yildiz T., Sonkaya E., Kavas M., Ozbaki F., Sertçelik L., Sen A., Sevim T. Diagnosis distribution in cases with granulomatous inflammation in lung, pleura, and lymph node biopsies: An experience from a tertiary level single center chest diseases and thoracic surgery hospital // Sarcoidosis Vasc. Diffuse Lung Dis. – 2022. – Vol. 38, № 4. – Р. e2021048. https://doi.org/10.36141/svdld.v38i4.11914
24. Grunewald J., Grutters J., Arkema E., Saketkoo L., Moller D., Müller-Quernheim J. Sarcoidosis // Nat Rev Dis Primers. – 2019. – Vol. 5, № 1. – P. 45. https://doi.org/10.1038/s41572-019-0096-x
25. Grutters J. Establishing a Diagnosis of Pulmonary Sarcoidosis // J Clin Med. – 2023. – Vol. 12, № 21. – P. 68-98. https:// doi.org/10.3390/jcm12216898
26. Hutton Klein J., Tazelaar H., Leslie K., Colby T. One hundred consecutive granulomas in a pulmonary pathology consultation practice // Am J Surg Pathol. – 2010. – Vol. 34, № 10. – P. 1456-1464. https://doi:10.1097/PAS.0b013e3181ef9fa0
27. Jacob M., Bastos H., Mota P., Melo N., Cunha R., Pereira J., Guimarães S., Moura C., Morais A. Diagnostic yield and safety of transbronchial cryobiopsy in Sarcoidosis // ERJ Open Res. – 2019. – Vol. 5, № 4. – P. 00203. https://doi.org/10.1183/23120541.00203-2019
28. Judson M., Boan A., Lackland D. The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States // Sarcoidosis Vasc Diffuse Lung Dis. – 2012. – Vol. 29, № 2. – P. 119-127. PMID: 23461074
29. Kalkanis A., Kalkanis D., Drougas D., Vavougios G., Datseris I., Judson M., Georgiou E. Correlation of spleen metabolism assessed by 18F-FDG PET with serum interleukin-2 receptor levels and other biomarkers in patients with untreated sarcoidosis // Nucl. Med. Commun. – 2016. – Vol. 37, № 3. – P. 273-277. https://doi.org/10.1097/MNM.0000000000000431
30. Keijsers R., Grutters J., Thomeer M., Du Bois R., Van Buul M., Lavalaye J., Van Den Bosch J., Verzijlbergen F. Imaging the inflammatory activity of sarcoidosis: Sensitivity inter observer agreement of 67Ga imaging and (18) F-FDG PET // Q J. Nucl. Med. Mol. Imaging. – 2011. – Vol. 55, № 1 – P. 66-71. PMID: 21242947
31. Kim J., Dabiri B., Hammer M. Micronodular lung disease on high-resolution CT: patterns and differential diagnosis // Clin Radiol. – 2021. – Vol. 76, № 6. – P. 399-406. https://doi.org/10.1016/j.crad.2020.12.025
32. Lynch J. 3rd, Ma Y., Koss M., White E. Pulmonary sarcoidosis // Semin Respir Crit Care Med. – 2007. – Vol. 28, № 1. – P. 53-74. https://doi.org/10.1055/s-2007-970333
33. Maller V., Weerakkody Y., Knipe H. Sarcoidosis (thoracic manifestations). Reference article, Radiopaedia.org. Available at: https://radiopaedia.org/articles/sarcoidosis-thoracic-manifestations-2?lang=us [Accessed on 13 Mar 2024].
34. Miller B., Rosado-de-christenson M., Mcadams H. Fishback N. Thoracic sarcoidosis: radiologic-pathologic correlation // RadioGraphics. – 1995. – Vol. 15, № 2. – P. 421-437. https://doi.org/10.1148/radiographics.15.2.7761646
35. Oberstein A., von Zitzewitz H., Schweden F., Müller-Quernheim J. Non invasive evaluation of the inflammatory activity in sarcoidosis with high-resolution computed tomography // Sarcoidosis Vasc Diffuse Lung Dis. – 1997. – Vol. 14, № 1. – P. 65-72. PMID: 9186991
36. Peng C., Talreja J., Steinbauer B., Shinki K., Koth L., Samavati L. Discovery of Two Novel Immunoepitopes and Development of Peptide-based Sarcoidosis Immunoassay // Am J Respir Crit Care Med. – 2024. – Vol. 210, № 7. – Р. 908-918. https://doi.org/10.1164/rccm.202306-1054OC
37. Prasse A., Katic C., Germann M., Buchwald A., Zissel G., Müller-Quernheim J. Phenotyping sarcoidosis from a pulmonary perspective // Am J Respir Crit Care Med. – 2008. – Vol. 177, № 3. – P. 330-336. https://doi.org/10.1164/rccm.200705-742OC
38. Qin D., Fan L., Zhong Y., Shen Y., Cheng D. Diagnostic accuracy of interleukin-2 receptor in sarcoidosis: a systematic review and meta-analysis // Expert Rev Respir Med. – 2023. – Vol. 17, № 6. – P. 495-505. https://doi.org/10.1080/17476348.2023.2225772
39. Rana G., d'Alessandro M., Rizzi L., Bergantini L., Cameli P., Vozza A., Sestini P., Suppressa P., Bargagli E. Clinical phenotyping in sarcoidosis management // Sarcoidosis Vasc Diffuse Lung Dis. – 2021. – Vol. 38, № 2. – Р. e2021007. https://doi.org/10.36141/svdld.v38i2.10423
40. Rossi G., Farver C. Pathological features and differential diagnosis. In: Bonella F., Culver D.A., Israël-Biet D., editors. Sarcoidosis (ERS Monograph) // Sheffield, European Respiratory Society. European Respiratory Society. Sheffield, UK, 2022. – pp. 91–106.
41. Sarangi P., Rock P., Bell D. Cluster of black pearls sign. Reference article, Radiopaedia.org. Available at: https://radiopaedia.org/articles/cluster-of-black-pearls-sign-1 [Accessed on 13 Mar 2024].
42. Spagnolo P., Sverzellati N., Wells A., Hansell D. Imaging aspects of the diagnosis of sarcoidosis // Eur Radiol. – 2014. – Vol. 24, № 4. – P. 807-816. https://doi.org/10.1007/s00330-013-3088-3
43. Starshinova A., Zinchenko Y., Filatov M., Denisova N., Istomina E., Landa S., Burdakov V., Churilov L., Sapozhnikova N., Pavlova M., Stepanenko T., Mayevskaya V., Yablonskiy P. Specific features of immune complexes in patients with sarcoidosis and pulmonary tuberculosis // Immunol Res. – 2018. – Vol. 66, № 6. – P. 737-743. https://doi.org/10.1007/s12026-018-9052-1
44. Talwar H. Rosati R., Li J., Kissner D., Ghosh S., Madrid F., Samavati L. Development of a T7 Phage Display Library to Detect Sarcoidosis and Tuberculosis by a Panel of Novel Antigens // EBioMedicine. – 2015. – Vol. 2, № 4. – P. 341-350. https://doi.org/10.1016/j.ebiom.2015.03.007
45. Trisolini R., Lazzari A., Tinelli C., De Silvestri A., Scotti V., Patelli M. Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations // Respirology. – 2015. – Vol. 20, № 2. – P. 226-34. https://doi.org/10.1111/resp.12449
46. Trisolini R., Spagnolo P., Baughman R. Principles of diagnosis. In: Bonella F, Culver DA, Israël-Biet D, eds. Sarcoidosis (ERS Monograph). Sheffield: European Respiratory Society, 2022. ISBN (online): 978-1-84984-146-7; ISBN (print): 978-1-84984-145-0.
47. van der Mark S., Bajnath V., Veltkamp M. Biomarkers in Sarcoidosis: Beginning of a New Era? // Clin Chest Med. – 2024. – Vol. 45, № 1. – P. 33-43. https://doi.org/10.1016/j.ccm.2023.09.002
48. Venkataramanan R., Pudhiavan A., Venkataramanan A. The "cluster of black pearls" sign of sarcoid lymphadenopathy: a new sign on thin-section contrast-enhanced multidetector CT. // Clin Radiol. – 2017. – Vol. 72, № 9. – P. 729-736. https://doi.org/10.1016/j.crad.2017.03.031
49. Wasfi Y., Rose C., Murphy J., Silveira L., Grutters J., Inoue Y., Judson M., Maier L. A new tool to assess sarcoidosis severity // Chest. – 2006. – Vol. 129, № 5. – P. 1234-1245. https://doi.org/10.1378/chest.129.5.1234
50. Wessendorf T., Bonella F., Costabel U. Diagnosis of sarcoidosis // Clinic Rev Allerg Immunol. – 2015. – Vol. 49, № 1. – P. 54-62. https://doi.org/10.1007/s12016-015-8475-x
Review
For citations:
Zinchenko Yu.S., Polyakova V.O., Muraviev A.N., Tubeeva I.R., Starevskaya S.V., Yablonskiy P.K. Ways to Enhance the Diagnosis of Pulmonary Sarcoidosis (Literature Review). Tuberculosis and Lung Diseases. 2025;103(2):102-110. (In Russ.) https://doi.org/10.58838/2075-1230-2025-103-2-102-110