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      Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline

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          Abstract

          Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.

          Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability.

          Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality.

          Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.

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          2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

          Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk-benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
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            IgG4-related disease.

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              HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis.

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                Author and article information

                Journal
                Am J Respir Crit Care Med
                Am. J. Respir. Crit. Care Med
                ajrccm
                American Journal of Respiratory and Critical Care Medicine
                American Thoracic Society
                1073-449X
                1535-4970
                15 April 2020
                15 April 2020
                15 April 2020
                15 April 2020
                : 201
                : 8
                : e26-e51
                Author notes
                Correspondence and requests for reprints should be addressed to Elliott D. Crouser, M.D., Division of Pulmonary and Critical Care Medicine, The Ohio State University, Columbus, OH 43220. E-mail: elliott.crouser@ 123456osumc.edu .
                [*]

                Co–first authors.

                Author information
                http://orcid.org/0000-0003-3197-6746
                http://orcid.org/0000-0001-6872-1769
                http://orcid.org/0000-0001-9132-4083
                http://orcid.org/0000-0001-9406-3130
                http://orcid.org/0000-0003-1586-0110
                http://orcid.org/0000-0002-8333-3403
                http://orcid.org/0000-0001-8813-5628
                http://orcid.org/0000-0001-7296-8975
                http://orcid.org/0000-0003-4944-1627
                http://orcid.org/0000-0002-4663-7985
                http://orcid.org/0000-0001-9541-3622
                Article
                202002-0251ST
                10.1164/rccm.202002-0251ST
                7159433
                32293205
                e12660c4-43de-4710-b8dd-c8b64fdaddc9
                Copyright © 2020 by the American Thoracic Society

                You may print one copy of this document at no charge. However, if you require more than one copy, you must place a reprint order. Domestic reprint orders: amy.schriver@ 123456sheridan.com ; international reprint orders: louisa.mott@ 123456springer.com .

                History
                Page count
                Figures: 3, Tables: 5, Pages: 26
                Categories
                American Thoracic Society Documents

                cardiac sarcoidosis,endobronchial ultrasound biopsy,pulmonary hypertension,rare lung disease,granuloma

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