Until recently, histologic support for sarcoidosis was usually obtained from an enlarged superficial lymph node or from a skin lesion. Then mass chest radiographic surveys revealed that bilateral hilar adenopathy was the earliest phase of sarcoidosis, appearing before the superficial lymphadenopathy and cutaneous lesions. Hence, other sources for tissue corroboration had to be sought. At present, the two commonly used techniques are the intracutaneous Kveim test and the prescalene fat-pad biopsy. A positive Kveim test has the added advantage of a high degree of specificity. False-positive reactions occur in only 1%-2% of cases.1 Other techniques include needle aspiration of the liver, muscle biopsy, and open-lung biopsy. Each, however, has major disadvantages; liver aspirate specimens disclose granulomas in many conditions other than sarcoidosis, whereas muscle biopsy yields the granulomas too erratically for routine use. Finally, limited open-lung biopsy requires entering the thoracic cavity, a procedure not lightly undertaken.
BRONCHIAL WALL BIOPSY IN SARCOIDOSIS. JAMA. 1963;183(8):683. doi:10.1001/jama.1963.03700080091020