Pulmonary sarcoidosis (staging)

Thoracic sarcoidosis can be staged on a chest radiograph with implications for prognosis although HRCT and FDG-PET provide more information to help guide treatment.

Usage

Chest radiographs have been the mainstay of staging thoracic sarcoidosis for many decades with fair interobserver concordance . However, this system correlates poorly with symptom severity, extrapulmonary disease, pulmonary function tests and need for treatment . HRCT and FDG-PET can provide more information than chest x-ray to help guide treatment decisions .

Classification

Scadding criteria

On PA chest radiographs, sarcoidosis can be classified into five stages :

• stage 0: normal chest radiograph
  • frequency at presentation: 5-15%
• stage I: hilar or mediastinal nodal enlargement only
  • frequency at presentation: 25-65%
  • spontaneous resolution: 60-90%
• stage II: nodal enlargement and parenchymal disease
  • frequency at presentation: 20-40%
  • spontaneous resolution: 40-70%
• stage III: parenchymal disease only
  • frequency at presentation: 10-15%
  • spontaneous resolution: 10-20%
• stage IV: end-stage lung disease (pulmonary fibrosis)
  • frequency at presentation: 5%
  • spontaneous resolution: 0%

Although in general patients progress from one stage to the next, this system does not correlate particularly well with clinical severity . In fact, chest x-ray appearances are often more dramatic than functional impairment .

History and etymology

In 1961, Scadding published a classification system adapted from one initially proposed by Karl Warm . Sometimes sarcoidosis is described as being staged with Siltzbach system , although this paper was not published until 1967 , and in turn, makes reference to classification systems already in place.

Siehe auch:

• Silzbach sarcoidosis chest radiographic staging system
• Sarkoidose Wurm Klassifikation
• Sarkoidose Scadding Stadium

und weiter:

• Sarkoidose