A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis

Oluwabukola Thomas-Orogan; Shaney L Barratt; Muhammad Zafran; Apollo Kwok; Anneliese Simons; Eoin P Judge; Matthew Wells; Richard Daly; Charles Sharp; Abiramy Jeyabalan; Martin Plummeridge; Ladli Chandratreya; Lisa G Spencer; Andrew R L Medford; Huzaifa I Adamali

doi:10.3390/diagnostics14030237

A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis

Oluwabukola Thomas-Orogan, Shaney L Barratt, Muhammad Zafran, Apollo Kwok, Anneliese Simons, Eoin P Judge, Matthew Wells, Richard Daly, Charles Sharp, Abiramy Jeyabalan, Martin Plummeridge, Ladli Chandratreya, Lisa G Spencer, Andrew R L Medford, Huzaifa I Adamali^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

INTRODUCTION: Sarcoidosis is a multi-system granulomatous disease most commonly involving the lungs. It may be incidentally diagnosed during imaging studies for other conditions or non-specific symptoms. The appropriate follow-up of incidentally diagnosed asymptomatic stage 1 disease has not been well defined.

OBJECTIVE: To define the clinical course of incidentally diagnosed asymptomatic stage 1 sarcoidosis and propose an algorithm for the follow-up of these patients.

METHODOLOGY: A retrospective case note analysis was performed of all EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration)-confirmed cases of stage 1 sarcoidosis presenting incidentally to Bristol and Liverpool Interstitial Lung Disease services. Clinical history, serology results, imaging scans, and lung function parameters were examined at baseline, 12, and 24 months. A cost analysis was performed comparing the cost of the current 2-year follow-up guidance to a 1 year follow-up period.

RESULTS: Sixty-seven patients were identified as the final cohort. There was no significant change in the pulmonary function tests over the two-year follow-up period. Radiological disease stability was observed in the majority of patients (58%, n = 29), and disease regression was evidenced in 40% (n = 20) at 1 year. Where imaging was performed at 2 years, the majority (69.8%, n = 37) had radiological evidence of disease regression, and 30.2% (n = 16) showed radiological evidence of stability. All patients remained asymptomatic and did not require therapeutic intervention over the study period.

CONCLUSIONS: Our results show that asymptomatic patients with incidental findings of thoracic lymph nodal non-caseating granulomas do not progress over a 2-year period. Our results suggest that the prolonged secondary-care follow-up of such patients may not be necessary. We propose that these patients are followed up for 1 year with a further year of patient-initiated follow-up (PIFU) prior to discharge.

Original language	English
Article number	237
Journal	Diagnostics
Volume	14
Issue number	3
DOIs	https://doi.org/10.3390/diagnostics14030237
Publication status	Published - 23 Jan 2024

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© 2024 by the authors.

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Academic Respiratory Unit

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Thomas-Orogan, O., Barratt, S. L., Zafran, M., Kwok, A., Simons, A., Judge, E. P., Wells, M., Daly, R., Sharp, C., Jeyabalan, A., Plummeridge, M., Chandratreya, L., Spencer, L. G., Medford, A. R. L., & Adamali, H. I. (2024). A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis. Diagnostics, 14(3), Article 237. https://doi.org/10.3390/diagnostics14030237

@article{88669625e65546ca8b5973e51fb47200,

title = "A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis",

abstract = "INTRODUCTION: Sarcoidosis is a multi-system granulomatous disease most commonly involving the lungs. It may be incidentally diagnosed during imaging studies for other conditions or non-specific symptoms. The appropriate follow-up of incidentally diagnosed asymptomatic stage 1 disease has not been well defined.OBJECTIVE: To define the clinical course of incidentally diagnosed asymptomatic stage 1 sarcoidosis and propose an algorithm for the follow-up of these patients.METHODOLOGY: A retrospective case note analysis was performed of all EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration)-confirmed cases of stage 1 sarcoidosis presenting incidentally to Bristol and Liverpool Interstitial Lung Disease services. Clinical history, serology results, imaging scans, and lung function parameters were examined at baseline, 12, and 24 months. A cost analysis was performed comparing the cost of the current 2-year follow-up guidance to a 1 year follow-up period.RESULTS: Sixty-seven patients were identified as the final cohort. There was no significant change in the pulmonary function tests over the two-year follow-up period. Radiological disease stability was observed in the majority of patients (58%, n = 29), and disease regression was evidenced in 40% (n = 20) at 1 year. Where imaging was performed at 2 years, the majority (69.8%, n = 37) had radiological evidence of disease regression, and 30.2% (n = 16) showed radiological evidence of stability. All patients remained asymptomatic and did not require therapeutic intervention over the study period.CONCLUSIONS: Our results show that asymptomatic patients with incidental findings of thoracic lymph nodal non-caseating granulomas do not progress over a 2-year period. Our results suggest that the prolonged secondary-care follow-up of such patients may not be necessary. We propose that these patients are followed up for 1 year with a further year of patient-initiated follow-up (PIFU) prior to discharge.",

author = "Oluwabukola Thomas-Orogan and Barratt, {Shaney L} and Muhammad Zafran and Apollo Kwok and Anneliese Simons and Judge, {Eoin P} and Matthew Wells and Richard Daly and Charles Sharp and Abiramy Jeyabalan and Martin Plummeridge and Ladli Chandratreya and Spencer, {Lisa G} and Medford, {Andrew R L} and Adamali, {Huzaifa I}",

note = "Publisher Copyright: {\textcopyright} 2024 by the authors.",

year = "2024",

month = jan,

day = "23",

doi = "10.3390/diagnostics14030237",

language = "English",

volume = "14",

journal = "Diagnostics",

issn = "2075-4418",

publisher = "MDPI AG",

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Thomas-Orogan, O, Barratt, SL, Zafran, M, Kwok, A, Simons, A, Judge, EP, Wells, M, Daly, R, Sharp, C, Jeyabalan, A, Plummeridge, M, Chandratreya, L, Spencer, LG, Medford, ARL & Adamali, HI 2024, 'A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis', Diagnostics, vol. 14, no. 3, 237. https://doi.org/10.3390/diagnostics14030237

TY - JOUR

T1 - A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis

AU - Thomas-Orogan, Oluwabukola

AU - Barratt, Shaney L

AU - Zafran, Muhammad

AU - Kwok, Apollo

AU - Simons, Anneliese

AU - Judge, Eoin P

AU - Wells, Matthew

AU - Daly, Richard

AU - Sharp, Charles

AU - Jeyabalan, Abiramy

AU - Plummeridge, Martin

AU - Chandratreya, Ladli

AU - Spencer, Lisa G

AU - Medford, Andrew R L

AU - Adamali, Huzaifa I

PY - 2024/1/23

Y1 - 2024/1/23

N2 - INTRODUCTION: Sarcoidosis is a multi-system granulomatous disease most commonly involving the lungs. It may be incidentally diagnosed during imaging studies for other conditions or non-specific symptoms. The appropriate follow-up of incidentally diagnosed asymptomatic stage 1 disease has not been well defined.OBJECTIVE: To define the clinical course of incidentally diagnosed asymptomatic stage 1 sarcoidosis and propose an algorithm for the follow-up of these patients.METHODOLOGY: A retrospective case note analysis was performed of all EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration)-confirmed cases of stage 1 sarcoidosis presenting incidentally to Bristol and Liverpool Interstitial Lung Disease services. Clinical history, serology results, imaging scans, and lung function parameters were examined at baseline, 12, and 24 months. A cost analysis was performed comparing the cost of the current 2-year follow-up guidance to a 1 year follow-up period.RESULTS: Sixty-seven patients were identified as the final cohort. There was no significant change in the pulmonary function tests over the two-year follow-up period. Radiological disease stability was observed in the majority of patients (58%, n = 29), and disease regression was evidenced in 40% (n = 20) at 1 year. Where imaging was performed at 2 years, the majority (69.8%, n = 37) had radiological evidence of disease regression, and 30.2% (n = 16) showed radiological evidence of stability. All patients remained asymptomatic and did not require therapeutic intervention over the study period.CONCLUSIONS: Our results show that asymptomatic patients with incidental findings of thoracic lymph nodal non-caseating granulomas do not progress over a 2-year period. Our results suggest that the prolonged secondary-care follow-up of such patients may not be necessary. We propose that these patients are followed up for 1 year with a further year of patient-initiated follow-up (PIFU) prior to discharge.

AB - INTRODUCTION: Sarcoidosis is a multi-system granulomatous disease most commonly involving the lungs. It may be incidentally diagnosed during imaging studies for other conditions or non-specific symptoms. The appropriate follow-up of incidentally diagnosed asymptomatic stage 1 disease has not been well defined.OBJECTIVE: To define the clinical course of incidentally diagnosed asymptomatic stage 1 sarcoidosis and propose an algorithm for the follow-up of these patients.METHODOLOGY: A retrospective case note analysis was performed of all EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration)-confirmed cases of stage 1 sarcoidosis presenting incidentally to Bristol and Liverpool Interstitial Lung Disease services. Clinical history, serology results, imaging scans, and lung function parameters were examined at baseline, 12, and 24 months. A cost analysis was performed comparing the cost of the current 2-year follow-up guidance to a 1 year follow-up period.RESULTS: Sixty-seven patients were identified as the final cohort. There was no significant change in the pulmonary function tests over the two-year follow-up period. Radiological disease stability was observed in the majority of patients (58%, n = 29), and disease regression was evidenced in 40% (n = 20) at 1 year. Where imaging was performed at 2 years, the majority (69.8%, n = 37) had radiological evidence of disease regression, and 30.2% (n = 16) showed radiological evidence of stability. All patients remained asymptomatic and did not require therapeutic intervention over the study period.CONCLUSIONS: Our results show that asymptomatic patients with incidental findings of thoracic lymph nodal non-caseating granulomas do not progress over a 2-year period. Our results suggest that the prolonged secondary-care follow-up of such patients may not be necessary. We propose that these patients are followed up for 1 year with a further year of patient-initiated follow-up (PIFU) prior to discharge.

U2 - 10.3390/diagnostics14030237

DO - 10.3390/diagnostics14030237

M3 - Article (Academic Journal)

C2 - 38337753

SN - 2075-4418

VL - 14

JO - Diagnostics

JF - Diagnostics

IS - 3

M1 - 237

ER -

A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis

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