{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:50:13Z","timestamp":1782514213959,"version":"3.54.5"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/diagnostics14030237","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T04:17:40Z","timestamp":1705983460000},"page":"237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis"],"prefix":"10.3390","volume":"14","author":[{"given":"Oluwabukola","family":"Thomas-Orogan","sequence":"first","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3067-7349","authenticated-orcid":false,"given":"Shaney L.","family":"Barratt","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Zafran","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3938-3500","authenticated-orcid":false,"given":"Apollo","family":"Kwok","sequence":"additional","affiliation":[{"name":"Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneliese","family":"Simons","sequence":"additional","affiliation":[{"name":"Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eoin P.","family":"Judge","sequence":"additional","affiliation":[{"name":"Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8683-3358","authenticated-orcid":false,"given":"Matthew","family":"Wells","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Daly","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-3625","authenticated-orcid":false,"given":"Charles","family":"Sharp","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7739-0595","authenticated-orcid":false,"given":"Abiramy","family":"Jeyabalan","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Plummeridge","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladli","family":"Chandratreya","sequence":"additional","affiliation":[{"name":"Department of Radiology, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3558-992X","authenticated-orcid":false,"given":"Lisa G.","family":"Spencer","sequence":"additional","affiliation":[{"name":"Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5445-5949","authenticated-orcid":false,"given":"Andrew R. L.","family":"Medford","sequence":"additional","affiliation":[{"name":"North Bristol Lung Centre, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huzaifa I.","family":"Adamali","sequence":"additional","affiliation":[{"name":"Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1164\/ajrccm.164.10.2104046","article-title":"Clinical characteristics of patients in a case control study of sarcoidosis","volume":"164","author":"Baughman","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/S0272-5231(05)70417-2","article-title":"Pulmonary sarcoidosis","volume":"18","author":"Lynch","year":"1997","journal-title":"Clin. Chest Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/S0140-6736(13)60680-7","article-title":"Sarcoidosis","volume":"383","author":"Valeyre","year":"2014","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1136\/thoraxjnl-2019-214348","article-title":"BTS Clinical Statement on pulmonary sarcoidosis","volume":"76","author":"Thillai","year":"2021","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/resp.12293","article-title":"Impact of needle gauge on characterization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) histology samples","volume":"19","author":"Jeyabalan","year":"2014","journal-title":"Respirology"},{"key":"ref_6","unstructured":"Statement on Sarcoidosis (1999). Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am. J. Respir. Crit. Care Med., 160, 736\u2013755."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2214\/AJR.04.1988","article-title":"Coronary artery imaging with contrast-enhanced MDCT: Extracardiac findings","volume":"187","author":"Haller","year":"2006","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/RCT.0b013e3181585ff2","article-title":"Prevalence of incidental findings in computed tomographic screening of the chest: A systematic review","volume":"32","author":"Jacobs","year":"2008","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/00005382-200404000-00004","article-title":"Non-cardiac findings on coronary electron beam computed tomography scanning","volume":"19","author":"Schragin","year":"2004","journal-title":"J. Thorac. Imaging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1148\/radiol.2392050261","article-title":"CT screening for lung cancer: Prevalence and incidence of mediastinal masses","volume":"239","author":"Henschke","year":"2006","journal-title":"Radiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1164\/ajrccm.165.4.2107006","article-title":"Screening for lung cancer with low-dose spiral computed tomography","volume":"165","author":"Swensen","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","first-page":"29","article-title":"Sarcoidosis: Epidemiology and prognosis. A 15-year European study","volume":"130","author":"Hillerdal","year":"1984","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1097\/JTO.0b013e31821d41c8","article-title":"Mediastinal Incidentalomas","volume":"6","author":"Stigt","year":"2011","journal-title":"J. Thorac. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"ACCESS Research Group (1999). Design of a Case Control Etiologic Study of Sarcoidosis (ACCESS). J. Clin. Epidemiol., 52, 1173\u20131186.","DOI":"10.1016\/S0895-4356(99)00142-0"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1136\/thx.2006.062836","article-title":"Incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK","volume":"61","author":"Gribbin","year":"2006","journal-title":"Thorax"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e000357","DOI":"10.1136\/bmjresp-2018-000357","article-title":"Sarcoidosis in the UK: Insights from British Thoracic Society registry data","volume":"6","author":"Thillai","year":"2019","journal-title":"BMJ Open Respir. Res."},{"key":"ref_17","first-page":"46","article-title":"Sarcoidosis in Denmark 1980\u20131994. A registry-based incidence study comprising 5536 patients","volume":"20","author":"Byg","year":"2003","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1183\/09031936.00197808","article-title":"Prevalence of sarcoidosis in Switzerland is associated with environmental factors","volume":"35","author":"Deubelbeiss","year":"2010","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1164\/rccm.200402-249OC","article-title":"A Case Control Etiologic Study of Sarcoidosis","volume":"170","author":"Newman","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1183\/13993003.00457-2016","article-title":"Sarcoidosis-related mortality in France: A multiple-cause-of-death analysis","volume":"48","author":"Jamilloux","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1701815","DOI":"10.1183\/13993003.01815-2017","article-title":"Sarcoidosis mortality in Sweden: A population-based cohort study","volume":"51","author":"Rossides","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_22","first-page":"130","article-title":"Optimal scoring of serial change on chest radiography in sarcoidosis","volume":"28","author":"Zappala","year":"2011","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis."},{"key":"ref_23","first-page":"15","article-title":"Interstitial lung diseases: Pathophysiology and respiratory function","volume":"14","author":"Gibson","year":"2000","journal-title":"Eur. Respir. Mon."},{"key":"ref_24","first-page":"105","article-title":"Pulmonary sarcoidosis","volume":"32","author":"Lynch","year":"2005","journal-title":"Eur. Respir. Monogr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0954-6111(06)80211-8","article-title":"Airflow limitation in sarcoidosis--a study of pulmonary function in 107 patients with newly diagnosed disease","volume":"85","author":"Harrison","year":"1991","journal-title":"Respir. Med."},{"key":"ref_26","first-page":"58","article-title":"Ventilatory disturbances in patients with intrathoracic sarcoidosis\u2014A study from a functional and histological perspective","volume":"34","author":"Calaras","year":"2017","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis. Off. J. WASOG"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1378\/chest.128.3.1483","article-title":"Distinctive clinical, radiographic, and functional characteristics of patients with sarcoidosis-related pulmonary hypertension","volume":"128","author":"Sulica","year":"2005","journal-title":"Chest"},{"key":"ref_28","first-page":"108","article-title":"Pulmonary hypertension in sarcoidosis","volume":"23","author":"Baughman","year":"2006","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1007\/s11547-012-0827-5","article-title":"Follow-up in pulmonary sarcoidosis: Comparison between HRCT and pulmonary function tests","volume":"117","author":"Sverzellati","year":"2012","journal-title":"Radiol. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1055\/s-0028-1112616","article-title":"The significance of stage classification of sarcoidosis (Boeck\u2019s disease)","volume":"85","author":"Wurm","year":"1960","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1136\/bmj.2.5261.1165","article-title":"Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years\u2019 observation","volume":"2","author":"Scadding","year":"1961","journal-title":"Br. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"F1000 Faculty Rev-600","DOI":"10.12688\/f1000research.11068.1","article-title":"Is it time to scrap Scadding and adopt computed tomography for initial evaluation of sarcoidosis?","volume":"7","author":"Levy","year":"2018","journal-title":"F1000Research"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e7595","DOI":"10.1097\/MD.0000000000007595","article-title":"Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: Cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain","volume":"96","author":"Villalba","year":"2017","journal-title":"Medicine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1148\/rg.306105512","article-title":"Pulmonary sarcoidosis: Typical and atypical manifestations at high-resolution CT with pathologic correlation","volume":"30","author":"Criado","year":"2010","journal-title":"Radiographics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1136\/thoraxjnl-2016-208833","article-title":"CTAS: A CT score to quantify disease activity in pulmonary sarcoidosis","volume":"71","author":"Benamore","year":"2016","journal-title":"Thorax"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1136\/thx.41.12.903","article-title":"Corticosteroid treatment in pulmonary sarcoidosis: Do serial lavage lymphocyte counts, serum angiotensin converting enzyme measurements, and gallium-67 scans help management?","volume":"41","author":"McAllister","year":"1986","journal-title":"Thorax"},{"key":"ref_37","first-page":"119","article-title":"The clinical course of sarcoidosis: Presentation, diagnosis, and treatment in a large white and black cohort in the United States","volume":"29","author":"Judson","year":"2012","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/3\/237\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:47:46Z","timestamp":1760104066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/3\/237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,23]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["diagnostics14030237"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14030237","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,23]]}}}