Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG最新文献

{"title":"Dual pathology, dual burden: Functional impact of emphysema and fibrosis in Hypersensitivity Pneumonitis.","authors":"Figen Öztürk Ergür, Ayperi Öztürk, Barış Akgül, Aydın Yılmaz, Ömür Güngör","doi":"10.36141/svdld.2026.18084","DOIUrl":"10.36141/svdld.2026.18084","url":null,"abstract":"<p><strong>Background and aim: </strong>Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease with heterogeneous presentations. In some patients, radiological coexistence of emphysema and fibrosis creates a distinct functional phenotype that complicates disease progression and management. To evaluate the functional impact of combined emphysema and fibrosis in HP patients and to identify clinical predictors associated with this dual pathology.</p><p><strong>Methods: </strong>We retrospectively analyzed 215 patients diagnosed with HP between 2010 and 2023. Demographic data, exposure history, radiological findings (HRCT), and pulmonary function parameters (FVC, DLCO, FEV₁) were collected. Patients were classified into three groups: fibrotic HP, non-fibrotic HP, and combined emphysema with fibrosis (CE-HP). Statistical analyses were performed using SPSS v22.0.</p><p><strong>Results: </strong>Of the 215 patients, 68 (31.6%) had fibrotic HP and 42 (19.5%) presented with CE-HP. Patients with CE-HP were significantly older (mean 66.2 ± 9.1 years) and more often male and smokers (p < 0.05). FVC and DLCO values were lower in CE-HP compared with non-fibrotic and fibrotic groups. A moderate negative correlation was found between extent of emphysema and DLCO (r = -0.56, p < 0.001). In multivariate analysis, age > 65 years, male gender, and smoking history were independent predictors of CE-HP development.</p><p><strong>Conclusions: </strong>The coexistence of emphysema and fibrosis in HP represents a distinct clinical phenotype with significant functional impairment. Recognition of this dual pathology is crucial for accurate prognostication and individualized management strategies.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18084"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone involvement in sarcoidosis: Insights from a multicentre Italian cohort.","authors":"Tommaso Pianigiani, Elisa Bianchi, Giulio Natalello, Roberto Barone, Francesca Aloe, Bianca Boncompagni, Elena Bargagli, Maria Antonietta Mazzei, Carla Caffarelli, Lucia Vietri, Alberto Papi, Luca Richeldi, Fabiano Di Marco, Paolo Cameli","doi":"10.36141/svdld.2026.17720","DOIUrl":"10.36141/svdld.2026.17720","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is a multisystemic granulomatous disease that can involve the skeletal system, although bone manifestations are considered relatively uncommon and often underdiagnosed.</p><p><strong>Objectives: </strong>To describe the prevalence, clinical characteristics, and treatment outcomes of bone involvement in a large multicenter Italian cohort of patients with sarcoidosis.</p><p><strong>Methods: </strong> This retrospective, two-center observational study included 867 patients with histologically confirmed sarcoidosis followed at two Italian referral centers (2018-2025). Bone localization was identified by imaging (PET/CT, MRI, X-ray) and/or biopsy. Clinical, functional, laboratory, and therapeutic data were collected.</p><p><strong>Results: </strong>Bone involvement was found in 46 patients (5.3%), predominantly women (58.7%), with mean age at diagnosis of 49.7 ± 12.2 years. Osseous lesions were most frequently localized in the axial skeleton, particularly pelvis (54.3%) and vertebrae (52.2%). Bone sarcoidosis was significantly associated with extra-thoracic lymphadenopathy, hepatic, and splenic involvement (p < 0.001), reflecting a pattern of clustered multi-organ disease. Osteoporosis and osteopenia were present in 15.2% and 13.0% of cases, respectively. Corticosteroid monotherapy was the most common initial treatment (56.5%), while 30.4% received combination therapy with csDMARDs or biologics. At one-year PET/CT re-evaluation, 56.5% showed a reduction of SUV at bone sites, with no significant correlation between therapeutic regimen and metabolic response.</p><p><strong>Conclusions: </strong>Bone involvement in sarcoidosis, though relatively rare, represents a clinically relevant phenotype strongly associated with hepatosplenic and lymphatic disease and characterized by a preferential axial skeleton localization. Recognition of this pattern is essential for diagnosis and management. Given the retrospective design and the limited follow-up sample, these findings should be interpreted with caution. Close radiological monitoring and tailored therapeutic strategies are warranted to improve outcomes.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"17720"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical remission in elderly patients with sarcoidosis.","authors":"Yohei Yatagai, Yosuke Maezawa, Toshihiro Shiozawa, Gen Ohara, Hiroaki Satoh","doi":"10.36141/svdld.2026.18237","DOIUrl":"10.36141/svdld.2026.18237","url":null,"abstract":"<p><p>None.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18237"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital Mortality Associated with Granulomatosis with Polyangiitis and Microscopic Polyangiitis Complicated with Respiratory Failure.","authors":"Francisco F Costa Filho, Vanita Motiani, Alan Furlan, Austin S Brubaker, Pranav Kidambi, Philip Kroth","doi":"10.36141/svdld.2026.18438","DOIUrl":"10.36141/svdld.2026.18438","url":null,"abstract":"<p><strong>Background and aim: </strong>Our study aimed to determine the in-hospital mortality rate among granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) hospitalizations complicated with acute respiratory failure (ARF) in the US and determine prognostic factors during hospitalization.</p><p><strong>Method: </strong>We performed a retrospective cohort analysis utilizing the National In-patient Sample (NIS) database to identify hospitalizations of patients with GPA or MPA associated with ARF from 2016 to 2021. The outcomes included in-hospital mortality, requirement of invasive procedures, and hospital length of stay. Univariable and multivariable analysis were used to identify prognostic factors associated with in-hospital mortality.</p><p><strong>Results: </strong>We identified 21,430 weighted (4,283 unweighted) hospitalizations with diagnosis of GPA or MPA associated with ARF in the United States from 2016 to 2021. 78.3% of those were diagnosed with GPA, 19.2% with MPA, and 2.5% with both ICD-10 codes. The mean age was 63.7 years, 53.6% were female, and 73.3% were White. The rate of hemodialysis was 21.5%, plasmapheresis 7.4%, and extracorporeal membrane oxygenation in 0.5% of hospitalizations. The overall in-hospital mortality was 15.4%, compared to 35.9% in the subgroup requiring invasive mechanical ventilation (IMV). Independent prognostic factors associated with increased in-hospital mortality were higher age, acute kidney injury (AKI), sepsis, requirement of non-invasive mechanical ventilation, interstitial lung disease (ILD), history of stroke, shock, and requirement of IMV.</p><p><strong>Conclusion: </strong>GPA or MPA hospitalizations complicated with ARF were found to be associated with a high in-hospital mortality rate. At hospital-level prognostication assessment, we found that higher age, AKI, sepsis, shock, history of ILD, history of stroke, and requirement of mechanical ventilation were independently associated with increased in-hospital mortality.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18438"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutoffs for serum mold-specific IgG levels for hypersensitivity pneumonitis: a diagnostic test accuracy study of 219 subjects.","authors":"Sahajal Dhooria, Ritesh Agarwal, Inderpaul Singh Sehgal, Valliappan Muthu, Kuruswamy Thurai Prasad, Shivaprakash M Rudramurthy, Nalini Gupta, Amanjit Bal, Mani Singh Meho, Mandeep Kaur, Mandeep Garg, Ashutosh Nath Aggarwal","doi":"10.36141/svdld.2026.18031","DOIUrl":"10.36141/svdld.2026.18031","url":null,"abstract":"<p><strong>Background: </strong>American Thoracic Society guidelines suggest serum specific IgG (sIgG) testing targeting potential antigens associated with hypersensitivity pneumonitis (HP). The diagnostic cutoffs of mold-sIgGs remain undefined and their performance based on pre- and post-test probabilities remain untested.</p><p><strong>Methods: </strong>We conducted a diagnostic test accuracy study using a case-control design. We enrolled subjects with HP (cases), other interstitial lung diseases (ILDs, diseased controls), and healthy controls with/without mold exposure. We measured sIgG against Aspergillus fumigatus, Penicillium chrysogenum, Cladosporium herbarum, and Micropolyspora faeni using an automated, fluorescent enzyme immunoassay. Cutoffs were derived from the 95th percentile values among non-exposed healthy controls for individual sIgGs and Youden's J-statistic for pooled sIgG (sum of four levels). We evaluated the performance characteristics of sIgG levels for HP diagnosis among subjects with ILDs.</p><p><strong>Results: </strong>We included 219 subjects (mean age, 51.4 years; 50.2% women): 105 HP, 64 non-HP ILDs, and 50 healthy controls (25 non-exposed, 25 exposed). Cutoffs (mgA/L) were 33, 22, 34, 8, and 53, for A. fumigatus, P. chrysogenum, C. herbarum, M. faeni, and pooled sIgG levels, respectively. The 4-mold panel (positive if any sIgG exceeded cutoff) showed 57.1% sensitivity and 78.1% specificity for HP diagnosis among ILD subjects. The pooled sIgG test (positive likelihood ratio, 3.29; negative likelihood ratio, 0.51) shifted post-test probability of HP diagnosis from 44% (for a negative test) to 84% (for a positive test).</p><p><strong>Conclusion: </strong>Mold-specific IgGs, when used at our proposed cutoffs, significantly alter post-test diagnostic probabilities; thus, can be used as an adjunct in multi-component HP diagnosis.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18031"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of a rapidly progressing, recurrent orbital mass.","authors":"Du Cheng, Sharanya Deshmukh, Leila Mabudian, Woon Chow, Nikisha Q Richards-Walker","doi":"10.36141/svdld.2026.18735","DOIUrl":"10.36141/svdld.2026.18735","url":null,"abstract":"<p><strong>Background and aim: </strong>We present a case of fast-growing, recurrent orbital mass which was ultimately diagnosed as sarcoidosis in a patient who lacked systemic symptoms.</p><p><strong>Methods: </strong>A case report was conducted.</p><p><strong>Results: </strong>A 58-year-old woman from Pakistan presented with a ortbial mass that is hyperintense orbital mass on MRI. Excisional biopsy and pathology revealed non-necrotizing granulomatous inflammation. Negative AFB culture, GMS, and flow cytometry ruled out TB and lymphoma. Chest X-ray was unremarkable. ACE and Lysozyme levels were marginally elevated. She presented with symptomatic recurrence of mass requiring repeat excision. Chest CT confirmed the presence of pulmonary nodules and hilar lymphadenopathy. She was started on corticosteroids and methotrexate with resolution of local inflammation and residual mass effect.</p><p><strong>Conclusions: </strong>Chest CT has higher sensitivity to aid definitive diagnosis in the setting of negative chest X-ray. Surgical treatment may be useful for diagnostic and therapeutic purposes. Subsequent long-term treatment with corticosteroids and antimetabolites has shown great response.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18735"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervised Home-Based Telerehabilitation for Idiopathic Pulmonary Fibrosis: A Pragmatic Service Evaluation in Routine Care with Detraining Follow-up.","authors":"Vasileios Stavrou, Konstantinos Korakas, Glykeria Tsirimona, Eleni Karetsi, Antonios Charokopos, Zoe Daniil","doi":"10.36141/svdld.2026.18236","DOIUrl":"10.36141/svdld.2026.18236","url":null,"abstract":"<p><strong>Background and aim: </strong>In this pragmatic, uncontrolled service evaluation in clinically stable idiopathic pulmonary fibrosis (IPF), we assessed primary service outcomes (feasibility and safety) and prespecified exploratory within-participant changes following a four-week supervised home-based tele-exercise program via the USTEP platform and a four-week detraining period.</p><p><strong>Methods: </strong>Thirteen participants were assessed at three prespecified time points (baseline: T0; post-intervention: T1; post-detraining: T2) using the six-minute walk test (6MWT), SF-36, HADS, and pulse-respiration quotient (PRQ). Primary service outcomes were captured as session attendance/adherence and exercise-related adverse events.</p><p><strong>Results: </strong>Adherence was 92% (median 11/12 sessions completed) and there were no exercise-related adverse events. The 6MWT distance increased by 8.4% from T0-T1 (Bonferroni-adjusted p=0.004, d=-1.15) but declined towards baseline at T2. SF-36 physical health scores increased at T1 (+5.2%) but decreased at T2 (Bonferroni-adjusted T1-T2 p=0.004, d=1.17). For several exploratory patient-reported outcomes (fatigue, pain and HADS), Bonferroni-adjusted comparisons were non-significant, while unadjusted testing suggested small T0-T1 changes; these are reported as exploratory signals. PRQ changed over time (χ²(2)=8.60, p=0.014), with a shift at T1 and a return to baseline at T2.</p><p><strong>Conclusions: </strong>In this small uncontrolled service evaluation, the program was feasible and safe and within-participant improvements were observed in 6MWT distance and selected patient-reported and physiological measures. These findings are exploratory and hypothesis-generating and should be confirmed in adequately powered controlled studies that include prespecified maintenance strategies.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18236"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features, diagnosis, and outcome of anaplastic lymphoma kinase tyrosine kinase inhibitors associated interstitial lung disease.","authors":"Zhaoquan Wu, Wei Sun, Chunjiang Wang","doi":"10.36141/svdld.2026.18699","DOIUrl":"10.36141/svdld.2026.18699","url":null,"abstract":"<p><p>Background To investigate the clinical features of anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKI) -associated interstitial lung disease (ILD), and to provide a reference for the rational use of ALK TKI. Methods Cases of ALK TKI-associated ILD before December 31, 2025 were collected by searching the database and clinical data were collected for retrospective analysis. Result Fifty patients were included, with a median age of 54.5 years (range 33, 86). The median time of ILD occurrence was 50 days (range 2, 630). Dyspnea (56.0%), hypoxemia (38.0%), cough (36.0%) and fever (26.0%) were the main clinical symptoms, and there may also be no symptoms. Computed tomography mainly showed ground-glass opacities (98.0%). After the patients discontinued ALK-TKI and received systemic steroid treatment, 90.0% of the patients had symptom relief and improved imaging, and 10.0% of the patients died. Conclusion ILD is a rare and fatal adverse event of ALK-TKI. The possibility of ILD should be considered if dyspnea, hypoxemia, and cough occur during ALK-TKI use. After ILD recovery, patients could switch to the same ALK-TKI or another ALK-TKI under the protection of glucocorticoid.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18699"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of AI chatbot-generated information on hypersensitivity pneumonitis for clinical and patient use.","authors":"Derya Yenibertiz, Güzide Tomas","doi":"10.36141/svdld.2026.18399","DOIUrl":"10.36141/svdld.2026.18399","url":null,"abstract":"<p><strong>Background and aim: </strong>Hypersensitivity pneumonitis (HP) is a complex, immüne mediated interstitial lung disease in which accurate diagnosis and long term management require integration of clinical, radiologic, and exposure-related information. Patients increasingly use artificial intelligence (AI) based chatbots to obtain disease related information; however, the quality, readability, and patient usability of such content remain unclear. This study aimed to evaluate the quality, reliability, readability, and patient-centered usability of AI chatbot generated information on HP.</p><p><strong>Materials and methods: </strong>Using Google Trends, we identified four of the most frequently searched patient-oriented questions regarding HP: (1) What is HP and what causes it? (2) What are the clinical features of HP? (3) How is HP treated? (4) How is HP diagnosed? These questions were submitted verbatim to eight AI chatbots (ChatGPT-5.1, Claude 3, Microsoft Copilot, DeepSeek V3, Gemini Pro, Grok 4, Kimi K2, Perplexity AI). A total of 32 responses were independently evaluated in a blinded fashion by four pulmonology professors specializing in interstitial lung diseases. Content quality and reliability were assessed using DISCERN; understandability and actionability with PEMAT-P; global written readability with the Written Readability Rating (WRR); and structural readability with the Flesch-Kincaid Grade Level (FKGL).</p><p><strong>Results: </strong>All chatbot outputs required advanced literacy, with FKGL scores ranging from 20.17 to 29.07 and a mean of approximately 24-25, indicating college or postgraduate reading level. No chatbot produced content within the recommended patient-appropriate range (FKGL ≤ 8). WRR scores declined with increasing clinical complexity, from 67.85 for definitional content (Q1) to 51.227 for diagnostic explanations (Q4). DISCERN scores varied substantially across models (35.001-57.103), with most chatbots falling into the \"fair-good\" range, reflecting partially reliable but incomplete information. [..] Conclusion: AI chatbots can generate clinically rich explanations of HP but currently produce content that is too complex and insufficiently actionable for most patients. [..].</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18399"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composite Inflammatory Indices for the Differentiation of Tuberculosis, Sarcoidosis, and Reactive Lymphadenopathy in Patients Undergoing EBUS-TBNA.","authors":"Buğra Kerget, Sırma Merve Çetin, Mustafa Buğra Coşkuner","doi":"10.36141/svdld.2026.18673","DOIUrl":"10.36141/svdld.2026.18673","url":null,"abstract":"<p><strong>Background: </strong>Differentiating mediastinal lymphadenopathy (LAP) due to tuberculosis, sarcoidosis, and reactive causes remains challenging because of overlapping clinical and radiological features. This study aimed to evaluate the diagnostic value of the systemic inflammation composite index (SICI), the platelet inflammation composite index (PICI), and other hematological indices for this differentiation.</p><p><strong>Methods: </strong>This retrospective study included 223 patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal LAP between 2020 and 2025. Pre-procedural laboratory data were used to calculate the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and the newly defined SICI and PICI.</p><p><strong>Results: </strong>PLR, NLR, SII, SICI, and PICI levels were highest in the tuberculosis group and were significantly higher in patients with granulomatous LAP than in those with reactive LAP (p < 0.001 for all). In differentiating tuberculosis from sarcoidosis, a SICI cut-off value of 10966.6 yielded a sensitivity of 83% and a specificity of 63%, while a PICI cut-off value of 2.2 yielded a sensitivity of 85% and a specificity of 60%. For distinguishing granulomatous from reactive LAP, the optimal cut-off values were 77.4 for PLR (sensitivity 98%, specificity 67%), 2721.5 for SICI (sensitivity 89%, specificity 63%), and 0.69 for PICI (sensitivity 87%, specificity 61%).</p><p><strong>Conclusion: </strong>SICI and PICI, introduced for the first time in the literature, are readily available composite indices that may aid in differentiating tuberculosis-, sarcoidosis-, and reactive LAP-related mediastinal LAP.</p>","PeriodicalId":502142,"journal":{"name":"Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG","volume":"43 2","pages":"18673"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}