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Comparative Study
. 2009 Jan-Feb;187(1):1-7.
doi: 10.1007/s00408-008-9111-9. Epub 2008 Aug 21.

Racial differences in sarcoidosis granuloma density

Robert R Burke  1 , Chad H Stone, Suzanne Havstad, Benjamin A Rybicki
Affiliations
Comparative Study

Racial differences in sarcoidosis granuloma density

Robert R Burke et al. Lung. 2009 Jan-Feb.

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.

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Figures

Fig. 1
Fig. 1
Method of granuloma counting. (a) Paraffin block with embedded lung biopsy tissue is (b) partitioned into three sections from which (c) three 4-μm-thick sections are cut and (d) mounted on three slides. At 4× magnification, the pathologist then identifies the slide with the greatest granuloma density (black box), (e) which is then examined under 10× magnification and the number of tissue pieces and granulomas counted
Fig. 2
Fig. 2
Distribution of granuloma density in lung tissue of Caucasian (n = 48) and African-American (n = 139) sarcoidosis patients
Fig. 3
Fig. 3
Negative binomial regression model predicted least-squares mean estimates of granuloma density by race, sex, and chest radiograph stage
See this image and copyright information in PMC

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