Correlation Between Parenchymal Findings on Computerized Tomography and Need for Symptomatic Treatment in Patients With Stage I Sarcoidosis

Abstract

SESSION TITLE: Pulmonary Manifestations of Systemic Diseases SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: Sarcoidosis is a multisystem disease most commonly affecting the lungs. Scadding stage I disease is defined as hilar lymphadenopathy without parenchymal involvement on chest radiography (CXR). Among patients with stage I disease the majority (60-90%) will have spontaneous regression without treatment. Prior studies have shown that the Scadding staging system underestimates the number of patients who have parenchymal involvement on Computerized Tomography (CT) scans. Our study sought to determine treatment rates in patients with stage 1 sarcoidosis by CXR and parenchymal disease on CT scan and to determine if certain parenchymal findings were associated with higher treatment rates. METHODS: This is a retrospective cohort study of 508 patients in a sarcoidosis database at a tertiary care center in the United States. Two thoracic radiologists independently reviewed and identified 19 patients with stage I disease by CXR who also had CT imaging, done within 3 months, with abnormal parenchymal findings. CT scans were analyzed for parenchymal findings including ground glass opacities (GGO), nodules and fibrosis. The electronic medical records of these patients were reviewed to identify those who needed treatment for pulmonary symptoms related to sarcoidosis. RESULTS: In our cohort of 19 patients, 84% were African-American and 68% were female. All but one patient with stage I disease by CXR (95%) had parenchymal findings on CT. On CT imaging, 12 (63%) patients had nodules only, 7 (37%) had GGO in combination with nodules or fibrosis. Of these 19 patients, 8 patients (42%) required treatment for symptomatic pulmonary sarcoidosis. On further characterization 4 (33%) of the 12 patients with nodules were treated and 4 (57%) of the 7 patients with GGO plus nodules or fibrosis were treated. CONCLUSIONS: We found a high treatment rate in our cohort of stage I sarcoidosis patients with parenchymal findings on CT. Those patients with GGO plus nodules/fibrosis on CT had higher treatment rates than those with nodules alone. This suggests that parenchymal findings on CT in stage I sarcoidosis patients may provide additional clinical value. CLINICAL IMPLICATIONS: Chest CT scans in patients with stage I sarcoidosis may have important prognostic implications and may help guide the clinician in making treatment decisions. DISCLOSURE: The following authors have nothing to disclose: Pratyaya Majumder, Anand Pariyadath, Robert Groves, Ennis James, Thomas Iden, Aamer Syed No Product/Research Disclosure Information