Pulmonary sarcoidosis (staging on chest radiograph)

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.


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 .


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.

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