Diagnostic modalities in sarcoidosis: BAL, EBUS, and PET

Semin Respir Crit Care Med. 2010 Aug;31(4):404-8. doi: 10.1055/s-0030-1262207. Epub 2010 Jul 27.


Advances have been made in minimally invasive diagnostic procedures in sarcoidosis, including bronchoalveolar lavage (BAL), endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA), and positron emission tomography (PET). Several independent groups found almost identical predictive values of the CD4:CD8 ratio in BAL for the diagnosis of sarcoidosis. A CD4:CD8 ratio greater than 3.5 shows a high specificity of 93 to 96% for sarcoidosis, but the sensitivity is low (53 to 59%). EBUS-TBNA is a safe and useful tool for diagnosing sarcoidosis stage I and II with a sensitivity of 83 to 93% and a specificity of 100%. Novel imaging techniques have been explored, such as PET using L-[3- (18)F] fluoro-alpha-methyltyrosine ( (18)F-F MT), which is more specific for malignancy than (18)F-fluorodeoxyglucose ( (18)F-FDG)-PET. The combined modality of FMT-PET with FDG-PET could successfully discriminate sarcoidosis from malignancy. These recent developments including novel biopsy procedures and novel imaging techniques could be of value to diagnosing sarcoidosis.

MeSH terms

  • Biopsy, Needle / methods
  • Bronchoalveolar Lavage / methods
  • CD4-CD8 Ratio / methods*
  • Humans
  • Positron-Emission Tomography / methods*
  • Predictive Value of Tests
  • Sarcoidosis / diagnosis*
  • Sarcoidosis / pathology
  • Sensitivity and Specificity
  • Ultrasonography, Interventional / methods