Table 4.

Different tissue sampling procedures and their diagnostic yield for the diagnosis of pulmonary sarcoidosis.

Method	Diagnostic Yield	Invasiveness	Granuloma	Lymphatic Pattern	Comments
Conventional transbronchial biopsy	High (up to 70–80%)	Intermediate/high	Yes	Yes	Sarcoid granulomas and lymphatic pattern may be appreciated; serial sections may be very helpful in highlighting granulomas when absent in the first slides
Transbronchial cryobiopsy	Very high (up to 100%)	High (10–15% pneumothorax; occasionally hemorrhagic events)	Yes	Yes	Very helpful in case of negative results from more conventional procedures and to avoid open-lung biopsy
Surgical lung biopsy	Very high (100%)	Very high (patients should be carefully selected); non-intubated, “awake” biopsy reduces complications	Yes	Yes	Limited to very challenging cases when transbronchial procedures failed to demonstrate granulomas (i.e., chronic form with hyaline sclerosis replacing granulomas and mimicking other ILDs)

Adapted Table 1 from Rossi G, Farver C. Sarcoidosis: pathological features and differential diagnosis. In Sarcoidosis (ERS Monograph); Bonella, F., Culver, D.A., Israël-Biet, D., Eds.; European Respiratory Society:Sheffield, UK, 2022; pp. 107–121 (https://doi.org/10.1183/2312508X.10031720), reproduced with permission of the © ERS 2023 [37].