Background:The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in the diagnosis of patients with early (Stage 1) sarcoidosis.Methods:From 1995 to 2006,seven patients (two males,five females),with ages ranging from 26 to 58 years,were impressed with Stage 1 sarcoidosis (mediastinal or hilar lymph nodes involvements without lung involvement) by histological examination of intrathoracic lymph nodes (LNs) and/or lung parenchyma taken from VATS biopsy.Three of them received PET or PET-CT evaluation.VATS was approached from the right and left side in one and six patients,respectively,according to the locations of their lesions.Results:All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis.Mediastinal LNs were taken from Groups 3,4 in four,Group 7 in two,and Groups 5,6 in one of them.Hilar LNs biopsies were performed in four cases.Lung biopsy was performed in all but two cases.All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis.PET-CT revealed high emission signals over these affected LNs.These patients received oral steroid treatment or follow up only.All of them were followed up from 5 months to 11 years with satisfactory results.Conclusion:VATS biopsy is a minimally invasive,safe and effective procedure.It can be used as a diagnostic alternative of transbronchial lung biopsy (TBLB),and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis.PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy.VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions,including the sarcoidosis.