Objective

To evaluate the clinical characteristics and outcomes of patients with asymptomatic pulmonary sarcoidosis (APS) detected incidentally and compare them with symptomatic non-Löfgren sarcoidosis (SnLS) patients.

Methods

Patients diagnosed as having APS at a University hospital in Barcelona, Spain, followed prospectively from 1976 to 2018. APS was defined as the presence of bilateral hilar lymphadenopathy (BHL) with or without lung parenchymal involvement discovered incidentally on chest radiograph or CT scan. APS was compared with SnLS.

Results

APS was diagnosed in 50 (13.6%) and SnLS in 317 (86.4%) patients. At diagnosis, stage I chest radiograph was significantly more frequent in APS than in SnLS (p < 0.001) and there were no asymptomatic patients with stages III and IV. SnLS showed more severe impairment in FVC (p = 0.009) and forced expiratory volume in 1st second (FEV1) (p = 0.003) than APS, while DLco was similar in both groups. Extrathoracic involvement at diagnosis and during the follow up was less frequent in APS than in SnLS patients (p < 0.005). Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS) was the most used diagnostic tool. Treatment was more frequently required in the SnLS than in APS (p < 0.001). At five years, APS patients showed less presence of active disease than SnLS (p = 0.054).

Conclusions

APS showed earlier radiological stages, lesser impairment in lung function, extrapulmonary organ involvement and need for treatment than SnLS. EBUS was the most useful diagnostic tool. In spite of its benign presentation, around one third of patients evolved to persistent disease but usually with mild clinical and functional impairment.

中文翻译：

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无症状肺结节病的临床特征和结局。一项比较队列研究。

目的

为了评估偶然发现的无症状肺结节病（APS）患者的临床特征和结局，并将其与有症状的非Löfgren结节病（SnLS）患者进行比较。

方法

1976年至2018年在西班牙巴塞罗那的一家大学医院中被诊断为患有APS的患者进行了随访。APS的定义是在胸部X光片或CT扫描中偶然发现或不发现肺实质受累的双侧肺门淋巴结病（BHL）的存在。将APS与SnLS进行比较。

结果

在50例（13.6％）中诊断出APS，在317例（86.4％）患者中诊断出SnLS。在诊断时，APS患者的I期胸部X线照片显着高于SnLS患者（p <0.001），并且没有无症状的III和IV期患者。SnLS显示FVC的严重损伤（p = 0.009）和第一秒钟的强制呼气量（FEV1）（p = 0.003）比APS严重，而DLco在两组中相似。与SnLS患者相比，APS诊断和随访期间的胸外受累频率较低（p <0.005）。支气管内超声引导下经支气管针抽吸术（EBUS）是最常用的诊断工具。与APS相比，SnLS中需要更频繁的治疗（p <0.001）。在5年时，APS患者显示出的活动性疾病少于SnLS（p = 0.054）。

结论

与SnLS相比，APS显示了更早的放射学阶段，更少的肺功能损害，肺外器官受累以及需要治疗。EBUS是最有用的诊断工具。尽管表现良好，但仍有约三分之一的患者演变为持续性疾病，但通常会有轻度的临床和功能障碍。