Scadding Criteria for Diagnosis of Sarcoidosis: Is There A Need For Change?

Abstract

PURPOSE:  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.METHODS:  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.RESULTS:  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.CONCLUSION:  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.CLINICAL IMPLICATIONS:  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.DISCLOSURE:  R. Sharma, None.