Chest
Volume 83, Issue 1, January 1983, Pages 128-133
Journal home page for Chest

Review
The Roentgenographic Staging of Sarcoidosis: Historic and Contemporary Perspectives

https://doi.org/10.1378/chest.83.1.128Get rights and content

The awareness that sarcoidosis can involve intrathoracic lymph nodes and lung parenchyma in sequential fashion evolved during the first half of this century. This awareness resulted in a roentgenographic staging system that has relevance to the course and prognosis, pulmonary function changes, and the symptom of dyspnea. The following definition or roentgenographic staging is proposed as the simplest, most reproducible system based solely on the roentgenographic appearance, avoiding histopathologic and pathophysiologic inferences. Stage I: bilateral hilar lymphadenopathy; stage II: bilateral hilar lymphadenopathy plus parenchymal infiltration; and stage IQ: parenchymal infiltration without bilateral hilar lymphadenopathy. The early data concerning bronchoalveolar lavage, determination of serum angiotensin-converting enzyme, and gallium 67 citrate scanning appear to have no clear relationships to staging, suggesting that staging continues to have unique value to the clinician in the classification of sarcoidosis and in the delineation of its clinical course and prognosis.

Section snippets

Course and Prognosis

Wurm, Reindell, and Heilmeyer14 found the best prognosis in patients with stage I disease, an intermediate prognosis in stage II, and the worst in stage III. In the report of Smellie and Hoyle,22 although they did not use a staging system, one can stage their patients on the basis of the data presented. They observed the natural course of 125 patients for more than two years from the time of discovery. Those presenting with hilar adenopathy alone (stage I) demonstrated spontaneous clearing of

Pulmonary Function

Winterbauer and Hutchinson24 have summarized the significance of pulmonary function testing in sarcoidosis. They noted that 80 percent of patients without roentgenographic evidence of parenchymal sarcoidosis, ie, stage I, had normal vital capacities, and 70 percent had normal diffusing capacities (Dco). With the advent of parenchymal change (stages II and III), only 35 percent had normal vital capacities and 34 percent normal Dcos. DeRemee and Andersen,25 reporting on 107 patients, noted that

Assessing Inflammatory Activity

Pulmonary sarcoidosis begins with an alveolitis composed chiefly of thymus-dependent lymphocytes (T cells).27 These elaborate chemotactic factors which attract monocytes, which ultimately transform into macrophages and epithelioid cells composing the granuloma. The granuloma may resolve either spontaneously or under the influence of glucocorticoids or be transformed into irreversible scar tissue by a process of hyalinization and fibrosis. These phases in the pathogenesis occur over variable

Summary and Conclusions

A large body of literature supports the legitimacy of roentgenographic staging in sarcoidosis. In fact, sarcoidosis is uniquely suited to this concept because of orderly progression on chest roentgenogram, its variable predilection for spontaneous resolution, the degree of pulmonary function changes, and frequency of dyspnea, all of which have been correlated with the chest roentgenogram findings. Some have questioned the validity of the putative, sequential development, since it is often

Acknowledgment

I wish to thank Mrs. Betty Marsh for her help in preparation of the manuscript.

References (35)

  • J Hutchinson

    Cases of Mortimer's malady

    Arch Surg (London)

    (1898)
  • E Besnier

    Lupus Pernio de la Face

    Ann Dermatol. Syph (Paris)

    (1889)
  • C Boeck

    Multiple benign sarkoid of the skin. J

    Cutan Dis

    (1899)
  • N Danbolt

    The historical aspects of sarcoidosis

    Postgrad Med J

    (1958)
  • C Boeck

    Fortgesetzte untersuchungen über das multiple benigne Sarkoid

    Arch Dermatol Res

    (1905)
  • E Kutnitzky et al.

    Boeckshes Sarcoid mit Beteiligung innerer Organe

    MMW

    (1915)
  • J Schaumann

    Etude sur le lupus pernio et ses rapports avec les sarcoides et la tuberculose

    Ann Dermatol Venereol

    (1916-17)
  • HJ Ustvedt

    Omkring det boeck'ske sarcoids nosografi og diagnose

    Nord Med

    (1939)
  • W Magnusson

    On the roentgen picture of the lungs and mediastinum in lymphogranulomatosis benigna

    Acta Med Scand

    (1940)
  • DS King

    Sarcoid disease as revealed in the chest roentgenogram

    AJR

    (1941)
  • S Löfgren

    Primary pulmonary sarcoidosis

    Acta Med Scand

    (1953)
  • JG Scadding

    Sarcoidosis with special reference to lung changes

    Br Med J

    (1950)
  • L Nitter

    Changes in the chest roentgenogram in Boeck's sarcoid of the lungs

    Acta Radiol [Suppl] (Stockh)

    (1953)
  • K Wurm et al.

    Der Lungenboeck im Röntgenbild

    (1958)
  • KM Citron

    Intrathoracic sarcoidosis

    Postgrad Med J

    (1958)
  • DG James et al.

    The course of sarcoidosis and its modification by treatment

    Lancet

    (1959)
  • LE Siltzbach

    Sarcoidosis: clinical features and management

    Med Clin North Am

    (1967)
  • Cited by (129)

    • Lung function decline in sarcoidosis

      2022, Respiratory Investigation
    • Roentgenogram, CT, and MRI

      2018, Sarcoidosis: A Clinician's Guide
    • Ultrasound characterization of ankle involvement in Löfgren syndrome

      2018, Joint Bone Spine
      Citation Excerpt :

      The results of the intradermal tuberculin test were recorded. Findings from minor salivary gland biopsy, chest radiographs, and chest-computed tomography (CT) were collected when available [27]. A standardized ultrasonography assessment including B-mode and power or color Doppler imaging was performed [28].

    View all citing articles on Scopus
    View full text