**Acknowledgements**

*Sarcoidosis and Granulomatosis - Diagnosis and Management*

and specificity of VATS reported in a meta-analysis were 92.7% (87.6–95.8%), 91% (89–92%), and 58% (31–81%), respectively [40]. VATS procedures have the advantage of technically enabling multilobed biopsies in comparison to open lung biopsy [41]. Currently, mini-VATS is also being increasingly considered given the less postoperative complications and decreased length of hospital stay [42, 43]. VATS procedure should be done by experienced thoracic surgeons, as there is a potential need for mini-thoracotomy in 25% of cases, to obtain adequate tissue for diagnosis [44]. Furthermore, there is a mortality rate of approximately 2% at 30 days associated with this surgical procedure as demonstrated by a meta-analysis conducted by

*Diagnostic approach in suspected pulmonary sarcoidosis. EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration; TBB, transbronchial biopsy; EBB, endobronchial biopsy; VATS, video-*

Sarcoidosis presents as a diagnostic dilemma in a number of medical specialties ranging from pulmonology, general internal medicine, rheumatology, and oncology to name a few. The advent of ultrasound-guided techniques (EBUS-TBNA, EUS-TBNA, and US-guided core biopsy of neck nodes) has significantly reduce the frequency of more invasive diagnostic procedures such as mediastinoscopy and surgical lung biopsies (both open and VATS biopsies). Moreover, TBB is rarely required to sample the lung parenchyma as the diagnostic yield of alternative procedures, with much less associated risk of pneumothorax (EBUS, EUS and US-guided core biopsy of neck nodes), is very high in appropriate clinical context. TBLC may be a newer diagnostic intervention being utilized in selected centers for histological

**24**

Wallis et al. [45].

**Figure 5.**

*assisted thoracoscopic biopsy [36].*

**3. Conclusion**

We thank Mr. John Hudson, the librarian at the New Cross Hospital, for his help with the literature review for this chapter.
