Ayçiçek Olcay, Bülbül Yılmaz, Öztuna Funda, Özlu Tevfik, Akkaya Selçuk
Department of Chest Diseases, Karadeniz Tecnichal University, Faculty of Medicine, Trabzon, Turkey.
Department of Radiology, Karadeniz Tecnichal University, Faculty of Medicine, Trabzon, Turkey.
Turk Thorac J. 2022 Jul;23(4):284-289. doi: 10.5152/TurkThoracJ.2022.21254.
In this study, it was aimed to investigate the diagnostic value of thorax computed tomography, which is a non-invasive method, in diagnosing sarcoidosis.
In our Faculty of Medicine, Department of Chest Diseases between January 1, 2013, and July 1, 2019, the data of 816 patients who underwent endobronchial ultrasonography for mediastinal lymph node sampling and other sampling methods, such as mediastinoscopy, thoracotomy, etc., if the histopathological diagnosis could not be reached, were retrospectively screened and 192 patients (sarcoidosis: 62, non-sarcoidosis: 130 patients) who met the inclusion criteria were included in the study. Patients diagnosed with sarcoidosis and patients diagnosed with non-sarcoidosis were compared in terms of thorax computed tomography findings (medi- astinal lymph nodes and lung parenchymal involvement).
Right upper paratracheal (72.6 vs. 46.9%, P = .001) and paraaortic lymph node involvement (79.0% vs. 60.8%, P = .01), hilar symmetry (88.5 vs. 58.3%, P < .001), and homogeneity in lymph nodes (80.6% vs. 56.9%, P = .001) were found to be significantly higher in the sarcoidosis group. Lymph node sizes were smaller in the sarcoidosis group and the mean density (51.3 Hounsfield unit vs. 44.1 Hounsfield unit, P = .002) was significantly higher. In the multivariate logistic regression analysis, the presence of homogeneity in the lymph nodes is 4.3-fold more likely to increase sarcoidosis, the presence of hilar symmetry 9.1-fold, the involvement of the right lower paratracheal lymph node 2.7-fold, the mean lymphadenopathy density >48 Hounsfield unit 4.3-fold, the maximum diameter of lymphadenopathy less than 27.5 mm 4.7-fold.
This study revealed that the localization, size, density, and homogeneity of mediastinal lymph nodes will help clinicians to diagnose patients with sarcoidosis without using invasive methods.
本研究旨在探讨作为一种非侵入性方法的胸部计算机断层扫描在结节病诊断中的价值。
在我们医学院胸科疾病科，对2013年1月1日至2019年7月1日期间816例行支气管内超声引导下纵隔淋巴结采样及其他采样方法（如纵隔镜检查、开胸手术等，若无法获得组织病理学诊断）的患者数据进行回顾性筛查，纳入符合纳入标准的192例患者（结节病：62例，非结节病：130例）。比较结节病诊断患者和非结节病诊断患者的胸部计算机断层扫描结果（纵隔淋巴结和肺实质受累情况）。
结节病组右上气管旁淋巴结受累（72.6%对46.9%，P = .001）和主动脉旁淋巴结受累（79.0%对60.8%，P = .01）、肺门对称性（88.5%对58.3%，P < .001）以及淋巴结均匀性（80.6%对56.9%，P = .001）显著更高。结节病组淋巴结大小更小，平均密度显著更高（51.3亨氏单位对44.1亨氏单位，P = .002）。在多因素逻辑回归分析中，淋巴结均匀性的存在使结节病增加的可能性高4.3倍，肺门对称性的存在高9.1倍，右下气管旁淋巴结受累高2.7倍，平均淋巴结病密度>48亨氏单位高4.3倍，淋巴结病最大直径小于27.5 mm高4.7倍。
本研究表明纵隔淋巴结的定位、大小、密度和均匀性将有助于临床医生在不使用侵入性方法的情况下诊断结节病患者。
