Sarcoidosis is a multisystem disease affecting young adults with pulmonary involvement as commonest clinical presentation. For diagnosis, clinical and radiological features of sarcoidosis must be supported by histological evidence of non-necrotizing granulomas. Scadding criteria (based on chest x-ray) is currently used to stage pulmonary sarcoid. However, use of computed tomography (CT) suggests that chest x-ray may incorrectly stage the disease in some patients. We studied clinical profile and staging of pulmonary sarcoidosis in 160 Indian patients.
Diagnosed patients of sarcoidosis were staged for disease by both chest x-rays (CXR) and CT by independent observers, using Scadding’s criteria which consists of : Stage 0: no lung involvement; Stage I: hilar enlargement alone; Stage II: hilar enlargement plus interstitial lung disease; Stage III: interstitial lung disease alone; and Stage IV: lung fibrosis.
Based on this 49(31%) patients had stage I, 71(44.3%) had stage II and 43 (26.8%)had stage III disease on CXR.CT revealed interstitial opacities in 27 of 49 (55%) patients with Stage I, in 71 and 43 patients (100% each) in stage II and III . Conventional chest skiagrams in stage I did not reveal involvement of lung parenchyma which was picked up on CT.However CT was comparble with chest skiagrams in stage II and III respectively. Thus 27 (55%) patients with stage I disease(on CXR) had involvement of lung parenchyma as well on CT classifying them as stage II.
Scadding criteria for staging sarcoidosis underestimates the extent of disease. CT on the other hand gives a correct picture of sarcoidosis. A classification based on CT chest would more accurately define the extent of disease. This has therapeutic and prognostic importance since most patients with stage I disease are not treated while symptomatic stage II disease requires treatment. Furthermore, chances of spontaneous remission are more in stage I.
Scadding criteria for staging pulmonary sarcoidosis needs to be redefined or a separate staging evolved based on CT, due to better delineation of disease by CT chest.
R. Sharma, None.