26th February 2025

Investigations in sarcoidosis

Blood tests can reveal hypercalcaemia or elevated serum ACE. ACE is produced by granulomas, so can be used to monitor disease activity as a marker of granuloma burden. 

Chest X-ray may show bi-hilar lymphadenopathy or pulmonary fibrosis. Findings are generally graded by the Scadding stages:

Table 6 Scadding staging system for sarcoidosis

Sarcoid can mimic many other diseases, including TB and malignancies, so tissue diagnosis is generally required. This can be obtained from the most easily accessible lesion, often using techniques such as EBUS.