Diagnosis and Detection of Sarcoidosis An Official American Thoracic Society Clinical Practice Guideline
Diagnosis and Detection of Sarcoidosis An Official American Thoracic Society Clinical Practice Guideline
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DOI：
10.1164/rccm.202002-0251st
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发表时间：
2020-04-15
影响因子：
24.7
通讯作者：
Baughman, Robert P.
中科院分区：
文献类型：
--
作者：
Crouser, Elliott D.;Maier, Lisa A.;Baughman, Robert P.
背景：结节病的诊断尚未标准化，但基于三个主要标准：兼容的临床表现、在一个或多个组织样本中发现非坏死性肉芽肿性炎症，以及排除肉芽肿性疾病的其他原因。没有普遍接受的措施来确定是否满足每个诊断标准；因此，结节病的诊断从来都不是完全安全的。方法：进行系统评价，并在适当时进行荟萃分析，以总结最佳的现有证据。使用建议分级、评估、开发和评估方法对证据进行评估，然后由多学科小组进行讨论。在专家小组权衡了期望和不良后果、估计的确定性、可行性和可接受性后，制定了支持或反对各种诊断测试的建议并进行分级。结果：总结了临床表现、组织病理学和替代诊断的排除。根据现有证据，专家委员会提出了 1 项基线血清钙检测的强烈建议、13 项有条件的建议和 1 项最佳实践声明。所有证据的质量都非常低。结论：专家组对证据进行了系统审查，为支持或反对疑似或已知结节病患者的各种诊断测试提供临床建议。随着新证据的出现，应重新审视这些证据和建议。
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability.Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality.Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.