Table 1.

Summary of current evidence-based recommendations on lymph node biopsy in patients suspected of sarcoidosis and presenting with mediastinal and/or hilar lymphadenopathy.

Clinical Context	Recommendation	Level of Evidence	Remark Experts
In patients for whom there is a high clinical suspicion for sarcoidosis (e.g., Löfgren’s syndrome, lupus pernio, or Heerfordt’s syndrome)	Lymph nodes sampling is not suggested (conditional recommendation)	Very low-quality evidence	Patients who do not undergo lymph node sampling require clinical follow-up
For patients presenting with asymptomatic, bilateral hilar lymphadenopathy			No recommendations for or against obtaining a lymph node sample can be made
For patients with suspected sarcoidosis and mediastinal and/or hilar lymphadenopathy for whom it has been determined that tissue sampling is necessary *	Endobronchial ultrasound (EBUS)-guided lymph node sampling, rather than mediastinoscopy, as the initial mediastinal and/or hilar lymph node sampling procedure is suggested (conditional recommendation)	Very low-quality evidence

Adapted from Crouser et al. [3]. * Criteria are (1) the desired diagnostic certainty, especially when an alternative diagnosis is reasonably possible; (2) the consideration of possible immunosuppressive treatment; and (3) when there is lack of skin and/or peripheral lymph node findings for a less risky and less invasive method of tissue sampling.