Use of likelihood ratios improves interpretation of laboratory testing for pulmonary sarcoidosis

Am J Clin Pathol. 2010 Dec;134(6):939-47. doi: 10.1309/AJCPNC7STHG0FWMP.

Abstract

Laboratory tests for pulmonary sarcoidosis (percentage lymphocytes and CD4/CD8 ratio in bronchoalveolar lavage fluid and serum angiotensin-converting enzyme activity) lack sensitivity and specificity. In a retrospective study of 153 subjects under suspicion of pulmonary sarcoidosis (36 cases and 117 patients with other diseases [control patients]), we defined likelihood ratios (LRs) for rationally selected result intervals of these tests, which improve clinical interpretation as compared with dichotomous interpretation based on a single cutoff value. By using logistic regression analysis, we further integrated the 3 individual tests into a unified algorithm that could rule out diagnosis in 57 (48.7%) of the 177 control subjects and confirm diagnosis in 12 (33%) of the 36 pulmonary sarcoidosis cases. We conclude that use of LRs improves interpretation of laboratory tests for pulmonary sarcoidosis. In addition, we present a prediction algorithm based on the combination of laboratory tests that helps clinicians confirm or exclude diagnosis in almost half of the study population.

Publication types

  • Validation Study

MeSH terms

  • Algorithms
  • Bronchoalveolar Lavage Fluid / chemistry
  • Bronchoalveolar Lavage Fluid / cytology
  • CD4-CD8 Ratio / statistics & numerical data
  • Clinical Laboratory Techniques / methods
  • Clinical Laboratory Techniques / standards
  • Clinical Laboratory Techniques / statistics & numerical data*
  • Data Interpretation, Statistical*
  • Female
  • Humans
  • Likelihood Functions
  • Logistic Models
  • Male
  • Retrospective Studies
  • Sarcoidosis, Pulmonary / blood
  • Sarcoidosis, Pulmonary / diagnosis*