The sarcoid granuloma has a histological structure that is similar to that seen in many other diseases. Some of its diagnostic features are negative, but an accurate diagnosis can be made from biopsy tissues if numerous, monotonously uniform granulomata are present. Histological confidence is often proportional to the number of granulomata seen in the specimen.
Mediastinal lymph nodes taken at mediastinoscopy have been positive in 90% of seventy-four patients with sarcoidosis.
Problems in the histological interpretation of Kveim biopsies may be due to failure to include the injection site in the biopsy, to inadequate sectioning of the specimen and to equivocal cellular reactions. Despite these difficulties, dual blind reading of sections of mediastinal lymph nodes and Kveim reaction biopsies from patients with sarcoidosis has shown that the observer variation that is likely to be of clinical significance is approximately 5% in each group.
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