Departments of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands.
J Thorac Oncol. 2011 Aug;6(8):1345-9. doi: 10.1097/JTO.0b013e31821d41c8.
Incidental mediastinal lymphadenopathy challenges pulmonologists to decide on eventual further diagnostic steps. The aim of this study was to characterize unexpected mediastinal findings by imaging and pathologic analysis.
Entry criterion for this prospective explorative study was mediastinal lymphadenopathy as an incidental finding on computed tomography (CT) scans made for indications other than the analysis and staging of neoplasms. Lymph node dimensions were measured on CT scan. Subsequent diagnostic investigations were positron emission tomography, endoscopic ultrasound- or endobronchial ultrasound-guided punctures, and clinical follow-up.
Eighty-three patients from eight hospitals met the entry criteria. The median number of Naruke stations with enlarged nodes was 7 (range 3-9). The median size of all nodes measured varied between 6 and 14 mm. The median number of lymph node stations with nodes of at least 10 mm was 3 (range 0-8). Hilar node enlargement was detected in 77% of patients. No definitive diagnosis was obtained in 7 of 83 (8%) patients. Lymphocytes were found in 55 of 83 (66%) and sarcoidosis in 18 of 83 (22%) of aspirates. Positron emission tomography showed metabolic activity in 87% of patients. Follow-up CT scans were available for 36 of 62 (58%) patients without a classifying diagnosis. Two patients developed lung cancer 2 years after initial analysis.
Incidental mediastinal lymph nodes on CT are characterized by multiplicity, relative small sizes, and coexistence with hilar lymphadenopathy in the majority of patients. These nodes often display increased metabolic activity. The low predictive value for malignancy justifies a restrictive attitude toward invasive diagnostic testing.
偶然发现的纵隔淋巴结肿大使肺病专家难以决定进一步的诊断步骤。本研究旨在通过影像学和病理分析来描述意外的纵隔发现。
本前瞻性探索性研究的入选标准为 CT 扫描偶然发现纵隔淋巴结肿大，而 CT 扫描并非用于分析和分期肿瘤。在 CT 扫描上测量淋巴结的大小。随后的诊断检查包括正电子发射断层扫描、内镜超声或支气管内超声引导下穿刺，以及临床随访。
来自 8 家医院的 83 名患者符合入选标准。Naruke 站肿大淋巴结中位数为 7 个（范围 3-9 个）。所有测量的淋巴结大小中位数在 6 至 14 毫米之间。至少有 10 毫米大小的淋巴结站数中位数为 3 个（范围 0-8 个）。77%的患者存在肺门淋巴结肿大。83 例患者中，有 7 例（8%）未获得明确诊断。55 例（66%）和 18 例（22%）的抽吸物中发现淋巴细胞和结节病。87%的患者的正电子发射断层扫描显示代谢活性。62 例（58%）无明确诊断的患者可获得 CT 随访扫描。2 例患者在初始分析后 2 年发生肺癌。
CT 偶然发现的纵隔淋巴结具有多发性、相对较小的大小以及多数患者存在肺门淋巴结肿大的特征。这些淋巴结通常显示代谢活性增加。恶性肿瘤的低预测值证明了对侵袭性诊断检测采取限制态度的合理性。
