Pathak Vikas, Adhikari Nawaraj, Conklin Courtney
Pulmonary and Critical Care, Virginia Institute of Lung Diseases, Richmond, USA.
Internal Medicine, Bon Secours Memorial Regional Medical Center, Mechanicsville, USA.
Cureus. 2023 Jul 14;15(7):e41867. doi: 10.7759/cureus.41867. eCollection 2023 Jul.
Background After identifying incidental mediastinal lymph nodes, decisions need to be made regarding the required follow-up imaging, the intervals at which this imaging should be performed, the types of imaging and procedures needed, and when to discontinue the follow-up. The purpose of this study is to determine the majority opinion on the management of these findings and provide recommendations for future management of incidental mediastinal lymphadenopathy. Methodology Sixty-two healthcare providers from a variety of specializations were surveyed on their preference for diagnostic workup and subsequent follow-up following the finding of incidental mediastinal lymphadenopathy on computed tomography (CT) of the chest. Results For thoracic lymphadenopathy of unclear etiology and patients who are not offered endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), most providers (47/62, 75.8%) initiate the CT scan follow-up at size 10 to 14 mm. Of those patients, 51.6% (32/62) of providers repeat the initial CT scan in three months and 41.9% (26/62) repeat the initial CT scan in six months. If the follow-up CT chest shows stable lymphadenopathy, 47.5% (29/62) repeat a CT chest every six months and 37% (23/62) repeat a CT chest every 12 months. The majority of providers (42/62, 67.7%) do not use positron emission tomography (PET)-CT for the initial evaluation of isolated thoracic lymphadenopathy and follow-up of lymphadenopathy with increasing size. For thoracic lymph nodes with a maximum diameter of 10 mm, only 4.8% (3/62) of providers continue CT screening after 24 months, while 24.6% (15/62) of providers continue CT screening after 24 months for sizes greater than 20 mm. Regarding the timing of EBUS-TBNA, 40.3% (25/62) of providers consider referring/performing this procedure at lymph nodes of size 11-15 mm, followed by 21% (13/62) of providers referring/performing the procedure at size 10 mm. Conclusions The majority of providers initiate CT scan follow-ups at 10 to 14 mm size for patients with isolated thoracic lymphadenopathy. The majority of providers do not use PET-CT for the initial evaluation of isolated thoracic lymphadenopathy. We found variable responses from providers regarding the timing of follow-up intervals and total duration. There is a need for consensus guidelines regarding the management of thoracic lymphadenopathy of unclear etiology.
背景 在发现纵隔淋巴结后，需要就所需的后续影像学检查、进行该影像学检查的间隔时间、所需的影像学检查类型和程序以及何时停止随访做出决策。本研究的目的是确定对这些检查结果管理的多数意见，并为未来偶发性纵隔淋巴结肿大的管理提供建议。
方法 对62名来自不同专业的医疗服务提供者进行了调查，了解他们在胸部计算机断层扫描（CT）发现偶发性纵隔淋巴结肿大后对诊断检查和后续随访的偏好。
结果 对于病因不明的胸部淋巴结肿大以及未接受支气管内超声引导下经支气管针吸活检（EBUS-TBNA）的患者，大多数提供者（47/62，75.8%）在淋巴结大小为10至14毫米时开始进行CT扫描随访。在这些患者中，51.6%（32/62）的提供者在三个月后重复进行初次CT扫描，41.9%（26/62）的提供者在六个月后重复进行初次CT扫描。如果随访的胸部CT显示淋巴结肿大稳定，47.5%（29/62）的提供者每六个月重复进行一次胸部CT扫描，37%（23/62）的提供者每12个月重复进行一次胸部CT扫描。大多数提供者（42/62，67.7%）在对孤立性胸部淋巴结肿大进行初始评估以及对逐渐增大的淋巴结肿大进行随访时不使用正电子发射断层扫描（PET）-CT。对于最大直径为10毫米的胸部淋巴结，只有4.8%（3/62）的提供者在24个月后继续进行CT筛查，而对于直径大于20毫米的淋巴结，24.6%（15/62）的提供者在24个月后继续进行CT筛查。关于EBUS-TBNA的时机，40.3%（25/62）的提供者考虑在淋巴结大小为11 - 15毫米时转诊/进行该检查，其次是21%（13/62）的提供者在淋巴结大小为10毫米时转诊/进行该检查。
结论 大多数提供者对孤立性胸部淋巴结肿大的患者在淋巴结大小为10至14毫米时开始进行CT扫描随访。大多数提供者在对孤立性胸部淋巴结肿大进行初始评估时不使用PET-CT。我们发现提供者在随访间隔时间和总时长的时机方面反应不一。对于病因不明的胸部淋巴结肿大的管理，需要达成共识性指南。
