title: Has mediastinoscopy still a role in suspected stage I sarcoidosis?
abstract: BACKGROUND
  Whether diagnostic mediastinoscopy is needed for confirmation of diagnosis in patients who present with clinical stage I sarcoidosis and no lung lesions on CT scan, is not known.
  
  
  METHODS
  A retrospectively review of all mediastinoscopies performed from 1992 to 2003 at Health Sciences center, Winnipeg, Canada yielded 55 patients with hilar and mediastinal lymphadenopathy and normal lung parenchyma on thoracic computerized axial Scan.
  
  
  RESULTS
  Out of a total of 1462 procedures, 55 patients with a presumptive diagnosis of Stage I sarcoidosis underwent mediastinoscopy. Median age at presentation was 47.4 +/- 12.8 years (range 24-77). The patients had mild symptoms of cough (30.9%), dyspnea (20.0%), chest pain (14.6%), malaise in (20.0%), erythema nodosum (3.6%) and uveitis (3.6%). Thoracic CT scan revealed bilateral hilar lymphadenopathy in 9 (16%), bilateral hilar lymphadenopathy plus right paratracheal lymphadenopathy in 35 (63%), right paratracheal lymphadenopathy in 7 (12%) and unilateral hilar lymphadenopathy in 4 (7.1%) subjects. Pathology revealed noncaseating granuloma, suggestive of sarcoidosis in 49 (89.1%), reactive lymph nodes in 5 (9.1%) and was nondiagnostic in 1 (1.8%). Only 2 out of these 6 non-sarcoid patients had bilateral hilar lymphadenopathy. Biopsy cultures were negative for fungus and mycobacterium in all patients.
  
  
  CONCLUSIONS
  Clinical presentation of minimal symptoms, mediastinal lymphadenopathy (especially bilateral hilar and right paratracheal lymphadenopathy) with normal parenchyma on CT scan strongly suggests a diagnosis of sarcoidosis. In these cases, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.
authors.affiliation: Sections of Pulmonary and Critical Care, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Smita Sakha
authors.initials: SS
authors.lastname: Pakhale
authors.forename: Helmut
authors.initials: H
authors.lastname: Unruh
authors.forename: Lawrence
authors.initials: L
authors.lastname: Tan
authors.forename: Sat
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis* / Q000473:pathology*