Involvement of the bronchial wall in sarcoidosis is more common than previously realized. The distinctive non-caseating, epithelioid-cell granulomas were found on bronchoscopic biopsy in 22 of 35 patients. Symptoms of bronchial obstruction were often absent, and the bronchial mucosa frequently had a normal appearance in spite of microscopic granulomatous involvement. Positive biopsies were obtained on bronchoscopy from 18 of 27 patients with disseminated pulmonary lesions, but even in 4 of 8 patients with bilateral hilar node enlargement alone, random bronchoscopic biopsies disclosed granulomatous seeding. Since bronchial granulomas persist into the late stage of pulmonary sarcoidosis, bronchial biopsy corroborates the diagnosis when other sources such as scalene fat pad and Nickerson-Kveim test sites may prove unrewarding. Random bronchoscopic biopsy adds a new and simple technique for the tissue diagnosis of intrathoracic sarcoidosis.
Friedman OH, Blaugrund SM, Siltzbach LE. Biopsy of the Bronchial Wall as an Aid in Diagnosis of Sarcoidosis. JAMA. 1963;183(8):646-650. doi:10.1001/jama.1963.03700080054015