The Role of Video Thoracoscopy in the Diagnosis of Sarcoidosis

Abstract

Sarcoidosis is a systemic autoimmune disease associated with the development of non-caseous granulomas. Early and accurate diagnosis of sarcoidosis is an important and difficult task, since the initial manifestations are diverse, nonspecific, and many patients are asymptomatic. Objective — to study the role of video thoracoscopy and to present our own experience of invasive diagnosis of sarcoidosis. Materials and methods. Patients included in the study were divided into 2 clinical groups depending on whether the diagnosis at admission coincided with the final diagnosis established after the morphological examination of lung biopsies or not. Group I — 74 patients with PDS and ML (41.6 %), whose diagnosis at admission coincided with the final clinical diagnosis (established on the basis of morphological examination of lung biopsies). Group II — 104 patients with PDS and ML (58.4 %), whose diagnosis upon admission did not coincide with the final clinical diagnosis. Results and discussion. Insufficient diagnosis of lung cancer (lung carcinomatosis) — 3 (2.9 %) cases at admission and 31 (29.8 %) cases after lung biopsy. The small percentage of diagnosis of interstitial, granulomatous lesions of the lungs or pneumonitis with systemic connective tissue pathology is also noteworthy - 3 (2.9 %) cases before lung biopsy and 19 (18.3 %) after. In patients who were diagnosed with pulmonary sarcoidosis without histological confirmation, such a pathology as tuberculosis was found in 14 (13.5 %), oncological lesion — 23 (22.1 %), interstitial or granulomatous lesion together with pneumonia in systemic pathology — 17 (16.3 %) and «other» — 20 (19.2 %) cases. We performed 178 VATS biopsies, among which lung biopsy prevailed — 67 (37.6 %) cases, pleural biopsy was the least performed — 18 (10.1 %) cases. Intraoperative complications were recorded in 2 (1.1 %) cases, in the form of bleeding from a lymph node, the elimination of which required the use of electrocoagulation, the use of local and systemic hemostatic agents. Postoperative complications were observed in 5 (2.8 %) cases and were caused by the lack of lung tightness and the resulting long-term discharge of air through the drainage. Conclusions. Manifestations of sarcoidosis often simulate other disseminated processes, so its invasive diagnosis is an effective and safe way of establishing the diagnosis, especially in complex cases and atypical clinical and radiological picture. Among invasive methods, preference should be given to mini-invasive methods, therefore, the optimal choice is VATS, which has high informativeness and a low percentage of postoperative complications and allows to evaluate a wide range of tissues such as the pleura, lymph nodes and lungs.