Abstract
Study Objectives While sarcoidosis generally inflicts a greater morbidity on African-American compared with Caucasian patients, no studies have examined whether racial differences exist in the intensity of the histologic hallmark of sarcoidosis, noncaseating granulomas. Design and Setting The study was conducted as a retrospective case series in a tertiary referral center. Patients The study included 187 patients with histopathologic confirmation of sarcoidosis by trans- and/or endobronchial biopsy between July 1991 and December 2001. Measurements and Results Granuloma density was the average number of granulomas per biopsy piece on the slide with the most intense granulomatous inflammation at fourfold magnification. Overall, African-American patients had a twofold greater median granuloma density than Caucasians (p = 0.005). In a negative binomial multivariate model, radiographic pattern had the strongest association with granuloma density, with Scadding stage II and III patients having adjusted granuloma densities of 60% (p = 0.005) and 105% (p = 0.0001) higher than stage I patients. In the specific-tissue types, radiographic stage–adjusted granuloma densities in African-American patients were 49% greater in bronchial tissue (p = 0.03), but only a 27% greater in alveolar tissue (p = 0.51). Conclusions A greater granuloma density in bronchiolar lung tissue of African-American sarcoidosis patients may explain racial differences in diagnostic yield by lung biopsy and disease severity at diagnosis. This association persists even after controlling for Scadding radiographic stage, a measure of disease severity strongly associated with granuloma density.
Similar content being viewed by others
References
Rybicki BA, Major M, Popovich JJ, Maliarik MJ, Iannuzzi MC (1997) Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol 145:234–241
Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R, Case Control Etiologic Study of Sarcoidosis (ACCESS) research group (2001) Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 164:1885–1889
Edmondstone WM, Wilson AG (1985) Sarcoidosis in Caucasians, Blacks and Asians in London. Br J Dis Chest 79:27–36. doi:10.1016/0007-0971(85)90004-X
Judson MA, Thompson BW, Rabin DL, Steimel J, Knattereud GL, Lackland DT, Rose C, Rand CS, Baughman RP, Teirstein AS, ACCESS Research Group (2003) The diagnostic pathway to sarcoidosis. Chest 123:406–412. doi:10.1378/chest.123.2.406
Teirstein AS, Judson MA, Baughman RP, Rossman MD, Yeager H Jr, Moller DR (2005) The spectrum of biopsy sites for the diagnosis of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 22:139–146
Torrington KG, Shorr AF, Parker JW (1997) Endobronchial disease and racial differences in pulmonary sarcoidosis. Chest 111:619–622. doi:10.1378/chest.111.3.619
Scadding JG (1961) Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years’ observation. BMJ 5261:1165–1172
Agresti A (1990) Categorical data analysis. New York, John Wiley & Sons, Inc
SAS Institute Inc (2002) SAS/STAT Users’ Guide, ver. 9, vol. 3. SAS Institute Inc, Cary, NC
Shorr AF, Torrington KG, Hnatiuk OW (2001) Endobronchial biopsy for sarcoidosis: a prospective study. Chest 120:109–114. doi:10.1378/chest.120.1.109
Westney GE, Judson MA (2006) Racial and ethnic disparities in sarcoidosis: from genetics to socioeconomics. Clin Chest Med 27:453–462. doi:10.1016/j.ccm.2006.04.002
Wasfi YS, Rose CS, Murphy JR, Silveira LJ, Grutters JC, Inoue Y, Judson MA, Maier LA (2006) A new tool to assess sarcoidosis severity. Chest 129:1234–1245. doi:10.1378/chest.129.5.1234
Westney GE, Habib S, Quarshie A (2007) Comorbid illnesses and chest radiographic severity in African-American sarcoidosis patients. Lung 185:131–137. doi:10.1007/s00408-007-9008-z
Evans M, Sharma O, LaBree L, Smith RE, Rao NA (2007) Differences in clinical findings between Caucasians and African Americans with biopsy-proven sarcoidosis. Ophthalmology 114:325–333. doi:10.1016/j.ophtha.2006.05.074
ATS/ERS/WASOG (1999) Statement on sarcoidosis. 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 160:736–755
Israel HL, Karlin P, Menduke H, DeLisser OG (1986) Factors affecting outcome of sarcoidosis. Influence of race, extrathoracic involvement, and initial radiologic lung lesions. Ann N Y Acad Sci 465:609–618. doi:10.1111/j.1749-6632.1986.tb18537.x
Hsu RM, Connors AF Jr, Tomashefski JF Jr (1996) Histologic, microbiologic, and clinical correlates of the diagnosis of sarcoidosis by transbronchial biopsy. Arch Pathol Lab Med 120:364–368
Gupta D, Jorapur V, Bambery P, Joshi K, Jindal SK (1997) Pulmonary sarcoidosis: spirometric correlation with transbronchial biopsy. Sarcoidosis Vasc Diffuse Lung Dis 14:77–80
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burke, R.R., Stone, C.H., Havstad, S. et al. Racial Differences in Sarcoidosis Granuloma Density. Lung 187, 1–7 (2009). https://doi.org/10.1007/s00408-008-9111-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-008-9111-9