PT - JOURNAL ARTICLE AU - Ahmed Fahim AU - David Rosewarne TI - The neck as mediastinal extension: diagnosis of sarcoidosis by core biopsy of cervical lymph nodes AID - 10.1183/13993003.congress-2016.PA821 DP - 2016 Sep 01 TA - European Respiratory Journal PG - PA821 VI - 48 IP - suppl 60 4099 - http://erj.ersjournals.com/content/48/suppl_60/PA821.short 4100 - http://erj.ersjournals.com/content/48/suppl_60/PA821.full SO - Eur Respir J2016 Sep 01; 48 AB - Aims and Objectives: Sarcoidosis is a multi-system granulomatous disease of uncertain aetiology. The diagnostic value of neck ultrasound with core biopsy for histological confirmation as a less invasive approach was evaluated. We describe 9 cases where histological diagnosis was made with US guided core biopsy to confirm clinically and radiologically suspected sarcoidosis.Methods: Nine patients were referred for sonographic evaluation of the head and neck to avoid the use of more invasive and expensive tests such as endobronchial ultrasound and mediastinoscopy. Typically these patients had no clinically apparent neck nodes. Where no cervical node suitable for biopsy was seen, the parotid glands were evaluated and biopsied if abnormal.Results: A diagnosis of sarcoidosis was made in all cases where a core biopsy was attempted. It is emphasised that the cervical lymph nodes in this series were not particularly enlarged, short axis dimensions being under 10mm in 6 of the 7 cases biopsied, and that these sub-centimeter lymph nodes did not have any specific sonographic appearances to mark them as pathological. Nevertheless histological examination revealed non-caseating granulomas in all cases. In a further two cases, where no neck nodes were seen, a histological diagnosis of sarcoidosis was made from biopsy of diffusely abnormal parotid gland tissue.Conclusions: Given the advantages of cervical diagnosis in terms of invasiveness and economy compared to mediastinal alternatives, it is suggested that where the expertise for core biopsy of normal sized cervical lymph nodes is readily available, the technique may be considered as a first line investigation for the diagnosis of sarcoidosis.