Scoping out sarcoidosis: the evolving role of bronchoscopy

The bronchoscopic approach to diagnosing sarcoidosis has evolved significantly with the advent of advanced endoscopic and imaging-guided modalities. Bronchoscopy remains the cornerstone for both histological confirmation and therapeutic intervention, offering minimally invasive access to the mediastinum, lung parenchyma and airways. This review integrates traditional techniques, including bronchoalveolar lavage, endobronchial biopsy and transbronchial biopsy, with advanced modalities such as endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial lung cryobiopsy, endobronchial ultrasound-guided intranodal forceps biopsy and mediastinal cryobiopsy. Emerging tools, including elastography and confocal laser endomicroscopy, are also explored for their potential to enhance diagnostic precision. A stage-based diagnostic algorithm is proposed to guide procedural choices tailored to clinical presentation. The role of bronchoscopy in diagnosing stage 0 and extrapulmonary sarcoidosis is discussed. This comprehensive update synthesises recent evidence to provide a practical framework for clinicians navigating complex diagnostic scenarios in sarcoidosis.