Department of Medical Imaging, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Curtin Medical School, Perth, Western Australia, Australia.
J Med Imaging Radiat Oncol. 2023 Oct;67(7):726-733. doi: 10.1111/1754-9485.13569. Epub 2023 Aug 7.
There is a lack of data on chest computed tomography (CT) findings on mediastinal lymph node enlargement (MLE), including normal size threshold of less than 10 or 15 mm for MLE among Indigenous Australians. In this study, we assessed the significance and the applicability of the current guidelines for the threshold for abnormal MLE among adult Indigenous Australians.
Patients who underwent chest CT between 2012 and 2020 among those referred to undergo lung function test (spirometry) were assessed for the presence of MLE which were classified as Group A (no measurable nodes), Group B (<10 mm), Group C (≥10 to 14.99 mm) and Group D (≥15 mm).
Of the total 67 patients identified to have MLE, 49 patients had at least two CT scans available for assessment over a median follow-up period of 101.3 weeks (IQR: 62.4, 235.6) and were included in the analysis. Evidence of chronic lung disease was common, with a significant proportion demonstrating either COPD or bronchiectasis and a high proportion with smoking history (93%). During the first CT scan, 34/49 (69%) had >10 mm nodes, of which 12/34 (35%) reduced in size, 22/34 (65%) remained stable, and 3/34 (9%) had malignancy on follow-up.
Despite most patients demonstrating the presence of significant MLE with varying size and in most >10 mm, the majority remain stable or benign in nature and only a minor proportion showed evidence of lung malignancy. Further prospective studies are needed in the characterisation of MLE among Indigenous patients.
目前缺乏有关纵隔淋巴结肿大（MLE）的胸部计算机断层扫描（CT）表现的数据，包括澳大利亚原住民中 MLE 的正常大小阈值（小于 10 或 15mm）。在这项研究中，我们评估了现行指南在评估成年澳大利亚原住民中异常 MLE 阈值的意义和适用性。
评估了 2012 年至 2020 年间因肺功能检查（肺活量测定）而接受胸部 CT 检查的患者是否存在 MLE，这些患者被分为 A 组（无可测量的淋巴结）、B 组（<10mm）、C 组（≥10 至 14.99mm）和 D 组（≥15mm）。
在总共确定有 MLE 的 67 名患者中，有 49 名患者至少有两次 CT 扫描可供评估，中位随访时间为 101.3 周（IQR：62.4，235.6），并纳入分析。慢性肺部疾病的证据很常见，有相当一部分患者表现为 COPD 或支气管扩张，且有很大比例的患者有吸烟史（93%）。在第一次 CT 扫描中，49/49（100%）患者的淋巴结>10mm，其中 12/34（35%）的淋巴结缩小，22/34（65%）的淋巴结保持稳定，3/34（9%）的淋巴结在随访中出现恶性肿瘤。
尽管大多数患者的 MLE 存在不同大小的显著肿大，其中大多数>10mm，但大多数患者的 MLE 保持稳定或良性，只有一小部分患者显示出肺部恶性肿瘤的证据。需要进一步进行前瞻性研究来描述澳大利亚原住民患者的 MLE。
