Characteristics of patients with a diagnosis of sarcoidosis: a comparison of the 2006 and 2015 versions of diagnostic criteria for sarcoidosis in Japan.
Characteristics of patients with a diagnosis of sarcoidosis: a comparison of the 2006 and 2015 versions of diagnostic criteria for sarcoidosis in Japan.
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DOI：
10.2185/jrm.2020-022
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
Bando M
中科院分区：
文献类型：
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作者：
Sakamoto N;Sawahata M;Yamanouchi Y;Konno S;Shijubo N;Yamaguchi T;Nakamura Y;Suzuki T;Hagiwara K;Bando M
目的：上皮样细胞肉芽肿的组织学检查对结节病的诊断具有重要意义；组织取样是一项世界性的要求。2006年，为了减少医疗费用和避免侵入性手术，日本政府允许不经组织学验证的诊断标准。2015年，新的诊断标准允许仅基于呼吸系统、眼系统和心脏系统进行临床诊断，至少涉及两个系统，这增加了对疑似结节病的临床无法评估器官取样的需要。本研究旨在比较根据2006年和2015年标准诊断结节病的患者的特征。材料与方法：采用2015年版，我们根据2006年版标准对2004 - 2012年间在暨南医科大学附属医院确诊或疑似结节病的264例患者（临床诊断84例，组织学诊断117例，疑似结节病63例）的特征进行重新评估。结果：39例患者由于没有至少两系统受累而被诊断为疑似结节病；2例患者没有足够的实验室资料提示结节病。6例患者从疑似结节病转移到组织学诊断，因为对支持性发现的标准更宽松。2015年诊断标准将不需要全身性类固醇的器官受累患者排除在临床诊断组之外。1例神经鞘瘤，根据2006年标准被错误地归入临床诊断组，根据2015年标准重新分类。结论：2015版对结节病的临床诊断较好，即使没有组织学标本，也能指导全身治疗的指征。
Objective: Histological verification of epithelioid cell granuloma is important in diagnosing sarcoidosis; tissue sampling is a worldwide requirement. In 2006, to reduce medical expenses and avoid invasive procedures, diagnostic criteria without histological verification were permitted by the Japanese government. In 2015, new diagnostic criteria, allowed clinical diagnoses based on only respiratory, ocular, and cardiac systems with at least a two-system involvement, increasing the need to sample tissue from clinically unevaluable organs in suspected sarcoidosis. This study aimed to compare the characteristics of patients who were diagnosed with sarcoidosis according to the 2006 and 2015 criteria. Materials and Methods: Using the 2015 version, we re-evaluated the characteristics of 264 patients with diagnosed or suspected sarcoidosis according to the 2006 criteria, at Jichi Medical University Hospital between 2004 and 2012 (clinical diagnosis, 84; histological diagnosis, 117; suspected sarcoidosis 63). Results: Thirty-nine patients were diagnosed with suspected sarcoidosis due to the absence of at least a two-system involvement; two patients had insufficient laboratory data suggestive of sarcoidosis. Six patients moved from suspected sarcoidosis to a histological diagnosis because of a greater leniency in the criteria for supportive findings. The 2015 diagnostic criteria excluded patients with organ involvement without a requirement for systemic steroids from the clinical diagnosis group. A case of schwannoma, erroneously placed in the clinical diagnosis group by the 2006 criteria, was reclassified according to the 2015 criteria. Conclusion: The 2015 version is preferable for clinically diagnosing sarcoidosis, even without histological specimens, and provides guidance for indications for systemic treatment.