Correlative analysis of longitudinal changes in bronchoalveolar lavage, 67gallium scanning, serum angiotensin-converting enzyme activity, chest X-ray, and pulmonary function tests in pulmonary sarcoidosis.

Despite the relatively high cost and complicated procedures, Gallium-67 (67Ga) scanning and bronchoalveolar lavage (BAL) are increasingly advocated as more sensitive indicators of disease activity in sarcoidosis than chest X-ray and serum angiotensin-converting enzyme activity (SACE). To evaluate the clinical usefulness of 67Ga scanning and BAL, we followed 31 patients with pulmonary sarcoidosis, using these four parameters, at 9- to 24-month intervals over periods of 9 to 48 months. We obtained 68 complete evaluations. Close correlations were observed among chest X-ray, 67Ga scanning, SACE, and the percentage of lymphocytes in BAL fluid (p less than 0.1 to 0.001). Longitudinal changes were also well correlated in these four parameters (p less than 0.001) and paralleled the changes in vital capacity (p less than 0.01 to 0.001). However, we were unable to predict the patients' outcome from the initial evaluation of these four parameters. These results suggest that, in terms of their usefulness for estimating disease activity, the differences among these four indicators are negligible. We therefore conclude that chest X-ray and SACE sufficiently reflect disease activity and that, at present, routine evaluation by 67Ga scanning and BAL are not necessarily indicated in the long-term management of pulmonary sarcoidosis.