Objectives To investigate the potential of computed tomography (CT)-based texture analysis and elastographic data provided by endobronchial ultrasonography (EBUS) for differentiating the mediastinal lymphadenopathy by sarcoidosis and small cell lung cancer (SCLC) metastasis. Methods Sixteen patients with sarcoidosis and 14 with SCLC were enrolled. On CT images showing the largest mediastinal lymph node, a fixed region of interest was drawn on the node, and texture features were automatically measured. Among the 30 patients, 19 (12 sarcoidosis and 7 SCLC) underwent endobronchial ultrasound transbronchial needle aspiration, and the fat-to-lesion strain ratio (FLR) was recorded. Texture features and FLRs were compared between the 2 patient groups. Logistic regression analysis was performed to evaluate the diagnostic accuracy of these measurements. Results Of the 31 texture features, the differences between 11 texture features of CT ROIs in the patients with sarcoidosis versus patients with SCLC were significant. Among them, the grey-level run length matrix with high gray-level run emphasis (GLRLM-HGRE) showed the greatest difference (P<0.01). Differences between FLRs were significant (P<0.05). Logistic regression analysis together with receiver operating characteristic curve analysis demonstrated that the FLR combined with the GLRLM-HGRE showed a high diagnostic accuracy (100% sensitivity, 92% specificity, 0.988 area under the curve) for discriminating between sarcoidosis and SCLC. Conclusion Texture analysis, particularly combined with the FLR, is useful for discriminating between mediastinal lymphadenopathy caused by sarcoidosis from that caused by metastasis from SCLC.

A 44-year-old man presented at our hospital to be evaluated for persistent fever and dyspnea. A chest computed tomography (CT) scan showed diffuse ground glass shadows and a left hilar tumor shadow. Upon further examination, he was found to have leukopenia, thrombocytopenia, and elevated lactate dehydrogenase and ferritin levels. He was diagnosed with both squamous cell lung carcinoma by a transbronchial lung biopsy and hemophagocytic syndrome by a bone marrow biopsy. After receiving treatment with dexamethasone and etoposide, the blood test abnormalities and performance status improved. Chemotherapy for lung cancer was initiated. He had a partial response after first-line chemotherapy and thereafter underwent left upper sleeve lobectomy.

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Rationale: To evaluate the potential of texture analysis using computed tomography (CT) to discriminate mediastinal lymphadenopathy caused by sarcoidosis from that caused by metastasis of small cell lung cancer (SCLC). Methods: A total of 30 patients, 16 with sarcoidosis and 14 with SCLC were enrolled. All patients demonstrated mediastinal lymphadenopathy on enhanced chest CT. On CT images showing the largest lymphadenopathy, a fixed-size round region of interest (ROI) was drawn on the lymphadenopathy, and 31 texture features were automatically measured. Among the 30 patients, 19 (12 with sarcoidosis and 7 with SCLC) underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and the fat-to-lesion strain ratio (FLR) was recorded. Texture features and the FLR were compared between the two patient groups using the Mann-Whitney test. In addition, logistic regression analyses were performed to evaluate the diagnostic accuracy of the FLR combined with texture features. Results: Of the 31 texture features, 11 showed significant differences between the sarcoidosis and SCLC patients. Among them, the grey-level run length matrix with high gray-level run emphasis (GLRLM-HGRE) showed the greatest difference (P<0.01). The FLR also showed a significant difference between the groups (P<0.05). Logistic regression analysis together with receiver operating characteristic analysis revealed that the FLR combined with the GLRLM-HGRE showed a high diagnostic accuracy (100% sensitivity, 92% specificity, 0.988 area under the curve) for discriminating sarcoidosis from SCLC. Conclusion: Texture analysis, particularly when combined with the FLR, is useful for discriminating mediastinal lymphadenopathy caused by sarcoidosis from that caused by SCLC metastasis.

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