From the Department of Radiology, Cardiothoracic Imaging, Duke University Medical Center, Durham, NC (H.C., H.P.M., P.K., E.F.P.); Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do, South Korea (Y.L.); and Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., Y.W.).
Radiology. 2022 Mar;302(3):684-692. doi: 10.1148/radiol.210522. Epub 2021 Nov 23.
Background There are currently no evidence-based guidelines for the management of enlarged mediastinal lymph nodes found on lung cancer screening (LCS) CT scans. Purpose To assess the frequency and clinical significance of enlarged mediastinal lymph nodes on the initial LCS CT scans in National Lung Screening Trial (NLST) participants. Materials and Methods A retrospective review of the NLST database identified all CT trial participants with at least one enlarged (≥1.0 cm) mediastinal lymph node identified by site readers on initial CT scans. Each study was reviewed independently by two thoracic radiologists to measure the two largest nodes and to record morphologic characteristics. Scans with extensively calcified mediastinal lymph nodes or nodes measuring less than 1 cm were excluded. Frequency and time to lung cancer diagnosis, lung cancer stage, and histologic findings were compared between NLST participants with and without lymphadenopathy. Results Of the 26 722 NLST participants, 422 (1.6%) had enlarged noncalcified mediastinal lymph nodes on the initial LCS CT scan. Mediastinal lymphadenopathy was associated with an increase in lung cancer cases (72 of 422 participants [17.1%; 95% CI: 13.6, 21.0] vs 1017 of 26 300 [3.9%; 95% CI: 3.6, 4.1]; < .001), earlier diagnosis (restricted mean survival time ± standard error, 2285 days ± 44 vs 2611 days ± 2; < .001), the presence of lung nodules ( < .001), advanced stage at presentation (22 of 72 participants [31%] with cancer at stage IIIA vs 410 of 1017 [40.3%] at stage IA; < .001), and increased mortality ( < .001). The majority of participants with lung cancers in the LCS group with mediastinal lymphadenopathy were detected at initial LCS CT (50 of 422 participants [11.8%; 95% CI: 8.9, 15.3] vs T1-T7, 22 of 422 [5.3%; 95% CI: 3.3, 7.8]; < .001). There was no association between mediastinal lymphadenopathy and lung cancer histologic findings, CT appearance, or location of lung nodules ( > .05 based on unadjusted pairwise association analyses). Conclusion Noncalcified mediastinal lymphadenopathy in the low-dose lung cancer screening study sample was associated with an increase in lung cancer, an earlier diagnosis, more advanced-stage disease, and increased mortality. More aggressive treatment of these patients appears warranted. © RSNA, 2021 See also the editorials by McLoud and by Mascalchi and Zompatori in this issue.
目前尚无针对肺癌筛查（LCS）CT 扫描中发现的增大纵隔淋巴结的循证管理指南。目的：评估国家肺癌筛查试验（NLST）参与者在初始 LCS CT 扫描中增大的纵隔淋巴结的频率和临床意义。材料与方法：对 NLST 数据库进行回顾性分析，确定了所有在初始 CT 扫描中至少有一个部位读片者确定的（≥1.0 cm）增大的纵隔淋巴结的 CT 试验参与者。由两位胸部放射科医生独立对每一项研究进行回顾，以测量两个最大的淋巴结并记录形态特征。排除广泛钙化的纵隔淋巴结或小于 1 cm 的淋巴结的研究。比较 NLST 参与者中有无淋巴结病的肺癌诊断频率、肺癌分期和组织学发现。结果：在 26722 名 NLST 参与者中，有 422 名（1.6%）在初始 LCS CT 扫描中出现非钙化性增大的纵隔淋巴结。纵隔淋巴结病与肺癌病例增加相关（72/422 例[17.1%；95%CI：13.6，21.0]与 26300/26722 例[3.9%；95%CI：3.6，4.1]；<.001），诊断时间更早（受限平均生存时间±标准误差，2285 天±44 与 2611 天±2；<.001），存在肺结节（<.001），分期更晚（72 例患者中有 22 例（31%）为 IIIA 期癌症，1017 例中有 410 例（40.3%）为 IA 期；<.001），死亡率增加（<.001）。LCS 组中纵隔淋巴结肿大的大多数肺癌患者在初始 LCS CT 时被发现（422 例患者中有 50 例[11.8%；95%CI：8.9，15.3]与 T1-T7，422 例患者中有 22 例[5.3%；95%CI：3.3，7.8]；<.001）。纵隔淋巴结肿大与肺癌的组织学发现、CT 表现或肺结节位置之间无关联（基于未调整的两两关联分析，>.05）。结论：低剂量肺癌筛查研究样本中非钙化性纵隔淋巴结肿大与肺癌增加、更早诊断、更晚期疾病和死亡率增加相关。似乎需要对这些患者进行更积极的治疗。
