title: The spectrum of biopsy sites for the diagnosis of sarcoidosis.
abstract: BACKGROUND
  The diagnosis of sarcoidosis is most secure when supported by a tissue biopsy exhibiting noncaseating epithelioid granulomas with absence of known granulomagenic agents in a patient with multi-organ disease. Clinicians must decide which site offers the best chance of achieving a diagnostic biopsy with the least patient risk and discomfort.
  
  
  METHODS
  736 cases were enrolled in the NHLBI supported A Case Controlled Etiologic Study of Sarcoidosis (ACCESS) from November 1996 to June 1999. All cases required diagnostic organ biopsy (Bx) exhibiting non-caseating epithelioid granulomas without identifiable granulomagenic agent, within six months of recruitment. Positive Kveim-Siltzbach test was accepted in patients with Löfgren's syndrome. Bx sites were correlated with demographic data, chest radiographic stages, symptoms, pulmonary function and associated organ involvement.
  
  
  RESULTS
  Seven hundred and seventy-six diagnostic biopsies were performed. Five hundred and sixty-seven were intrathoracic, 198 extrathoracic. Eleven Kveim tests were positive. When cutaneous sarcoidosis or an enlarged extrathoracic lymph node was present, skin or lymph node Bx was the preferred procedure. Twenty-three different organs yielded diagnostic biopsies.
  
  
  CONCLUSIONS
  Biopsy diagnosis in sarcoidosis is almost always easily obtained. As shown by ACCESS, sarcoidosis offers a wide spectrum of diagnostic biopsy sites. The choice for biopsy is influenced by the presenting clinical constellation of organ involvement and the ease and safety of the biopsy procedure.
authors.affiliation: Mount Sinai Medical Center, New York, NY 10029, USA. alvin.teirstein@msnyuhealth.org
authors.forename: Alvin S
authors.initials: AS
authors.lastname: Teirstein
authors.forename: Marc A
authors.initials: MA
authors.lastname: Judson
authors.forename: Robert P
authors.initials: RP
authors.lastname: Baughman
authors.forename: Milton D
authors.initials: MD
authors.lastname: Rossman
authors.forename: Henry
authors.initials: H
authors.lastname: Yeager
authors.forename: David R
authors.initials: DR
authors.lastname: Moller
mesh_terms: D000293:Adolescent; D001706:Biopsy; D003657:Decision Making; D004064:Digestive System / Q000473:pathology; D005123:Eye / Q000473:pathology; D006801:Humans; D008221:Lymphoid Tissue / Q000473:pathology; D009132:Muscles / Q000473:pathology; D012137:Respiratory System / Q000473:pathology; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis*