S87 2-year follow up of patients with incidental findings of thoracic lymph-nodal non-caseating granulomas

IntroductionSarcoidosis is a multi-system granulomatous disease. Thoracic involvement can sometimes present asymptomatically, only being detected incidentally during imaging studies for other conditions or non-specific symptoms. Appropriate follow up of these patients has not been well defined.ObjectiveTo define the clinical course of incidentally identified Scadding stage 1 sarcoidosis.MethodologyRetrospective case note analysis of endobronchial-ultrasound guided lymph node biopsy confirmed cases of sarcoidosis was undertaken. These were patients who presented incidentally to Bristol and Liverpool ILD services, with Scadding stage 1 disease. Clinical features, lung function parameters and radiological staging were examined at baseline, 12 and 24 months. We hypothesized that there would be no progression of disease in these patients. T-test was used with statistical significance of p< 0.05. ResultsFifty-two cases were identified; 52% were male. The cohort had a median (IQR) age of 54 (43–63) years, and baseline FEV1 of 99 (86–112)%, FVC of 106 (99–119)%, FEV1/FVC ratio of 76 (72–81)% and TLCO of 90 (76–102)%.All patients were asymptomatic in terms of fatigue, arthralgia, eye and respiratory symptoms at baseline. Baseline calcium was normal in all patients.At 12 months there was no significant change in FEV1 3.21 ± 9.44% (n=24; p= 0.75) and FVC 0.47 ±7.44% (n=23; p= 0.68) compared to baseline. At 24 months there was also no significant change in FEV1 1.17 ±12.2% (n=11; p= 0.90) and FVC -0.66% ±10.96% (n=10; p= 0.49) compared to baseline.Chest X-rays showed stability or regression in 90.3% of cases (n=31) at 12.7 ±4.9 months and 100% of cases (n=17) at 23.9 ±4.2 months.No patients required therapeutic intervention over 24 months of follow up, for organ threatening disease or symptoms deemed by patient and/or physician to be significantly impacting on quality of life.Furthermore, no patients went on to develop any symptomatic features attributable to sarcoidosis during the study period.ConclusionOur results show that patients with incidental findings of non-caseating granulomas and Stage 1 disease at baseline remain asymptomatic over a 24 month period. Our results suggest that prolonged follow up is unnecessary.ReferenceScadding JG, Mitchell DN. Sarcoidosis. London: Chapman & Hall, 1985.