A retrospective observational study of benign anthracotic lymphadenitis and its association with PET avid lymph nodes in patients undergoing cancer evaluation

Ivanick, Nathaniel; Shrestha, Pavan; Podolsky, Michael J.; Walavalkar, Vighnesh; Lucas, Calixto-Hope G; Gesthalter, Yaron; Seeley, E. Scott

doi:10.21037/jtd-21-142

Cited by 5 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As highlighted previously, 30 An important role of EBUS-TBNA cytology is to identify whether PET-avid or enlarged lymph nodes result from malignant involvement or whether they represent benign pathologies such as anthracosilicosis or inflammatory processes. 32,33 In 10 lymph nodes in our cohort, anthracosilicosis was identified on review but was not mentioned in the original cytopathology report. Although this error would not alter the subsequent surgical management of the patient and may not be considered a critical omission, anthracosilicosis is common in lung cancer cohorts and its link to lymph node PET avidity is well-established.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of endobronchial ultrasound‐guided transbronchial needle aspiration for staging of non‐small cell lung cancer

Chung,

Bentel,

Laycock

2024

Diagnostic Cytopathology

View full text Add to dashboard Cite

BackgroundEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is routinely performed to confirm a lung cancer diagnosis and/or to clinically stage disease. EBUS‐TBNA findings may be used to determine whether patients can be offered potentially curative surgery. In this study, we evaluated the reporting in our service of EBUS‐TBNA cytology for early‐stage (operable) non‐small cell lung cancer (NSCLC), focusing on diagnostic accuracy and analyzing cases with discordant cytologic and post‐surgical histopathologic conclusions.MethodsCytology slides and cytopathology reports of 120 NSCLC patients who had undergone EBUS‐TBNA and lobectomy in our hospital system between 2015 and 2021 were retrospectively reviewed.ResultsOf 290 lymph nodes (110 cases) able to be reviewed, interpretation of 48 lymph nodes was discordant with the original cytopathology report. This included 31 lymph nodes originally reported as adequate, which were found to be non‐diagnostic on review. The diagnostic accuracy (benign/malignant) of lymph nodes that were sampled at EBUS‐TBNA and excised at surgery was 89%. Specific examination of cases where EBUS‐TBNA cytology did not reflect post‐surgical findings illustrated important features and limitations of the procedure. These included potential misclassification of lymph node stations, the presence of multiple, variably involved nodes at lymph node stations, and the failure to detect small volume disease.ConclusionsContinuous evaluation of EBUS‐TBNA performance identifies technical limitations and areas of improvement for cytopathology reporting. This is increasingly important in an era where lung cancer screening is expected to increase diagnosis of early‐stage disease and with the advent of novel treatments, including non‐surgical management options.

show abstract

Section: Discussionmentioning

confidence: 99%

Accuracy of endobronchial ultrasound‐guided transbronchial needle aspiration for staging of non‐small cell lung cancer

Chung,

Bentel,

Laycock

2024

Diagnostic Cytopathology

View full text Add to dashboard Cite

show abstract

“…Similarly a very small biopsy of a neuroendocrine tumour such as carcinoid, may masquerade as a SCLC due to marked crush artefact (Fig. 4 A relatively common non-malignant finding in EBUS specimens of mildly fluorodeoxiglucose (FDG) avid lymph nodes, is the presence of anthracosis [19].…”

Section: Andandmentioning

confidence: 99%

“…A relatively common non-malignant finding in EBUS specimens of mildly fluorodeoxiglucose (FDG) avid lymph nodes, is the presence of anthracosis [19].…”

Section: Histologic-cytologic Diagnosis Of Lung Cancermentioning

confidence: 99%

Practical challenges in lung cancer pathology: bedside care to treatment decisions

Takano,

Chow,

Lim

2023

Current Opinion in Pulmonary Medicine

View full text Add to dashboard Cite

Purpose of review Lung cancer is one of the most common malignancies in the whole world, and the pulmonologist is generally the first medical professional to meet the patient and decide what method of tumour sampling is preferable in each specific case. It is imperative for pulmonary physicians to be aware of the intricacies of the diagnostic process, and understand the multiple challenges that are encountered, from the moment the tissue specimen leaves their offices and is sent to the pathology laboratory, until the diagnosis reaches the patient and treating physician. Recent findings The new 2021 WHO classification of thoracic tumours recommended a minimum immunohistochemical (IHC) diagnostic panel for nonsmall cell lung cancer (NSCLC), and following publications of different institutional and country-based guidelines, advocated basic molecular testing for epithelial growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and programmed cell death ligand 1 (PD-L1) to be initiated by the diagnosing pathologist in all cases of biopsy or resection specimens. In general, sequential testing for molecular biomarkers was not recommended due to tissue wastage, instead next generation sequencing (NGS) diagnostic panel was supported. Summary The lung cancer specimen has to undergo histologic diagnosis through a panel of IHC studies, and –preferably, a reflex molecular study by NGS including several targetable genes. Adequate communication and clinical information preclude the pathologist from “overusing” the tissue for additional studies, while focusing on preservation of material for molecular testing.

show abstract

“…Although it is predominantly a respiratory disease, cases of systemic involvement presenting with disseminated lymphadenopathy have been infrequently reported [ 2 ]. In some studies, it has also been associated with smoking, infectious diseases such as tuberculosis, and malignancies [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Evaluation traditionally involved mediastinoscopy but has recently been superseded by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scans are also currently used to diagnose metastatic disease, but false positives have been known to occur in metabolically active benign diseases that manifest increased FDG uptake, one of which is nodal anthracosis [ 3 , 5 ]. We describe a patient who presented with B-symptoms and diffuse lymphadenopathy, was found to have hypermetabolic mediastinal lymph nodes on an FDG PET/CT scan, and was diagnosed with this infrequently described condition.…”

Section: Introductionmentioning

confidence: 99%

The Curious Case of the Black Buboes

Saha¹,

Kanamgode²,

Mitra³

2022

Cureus

View full text Add to dashboard Cite

Anthracosis is an environmental lung disease caused by carbon deposition and pigmentation in the airways. However, in rare instances, it can also have systemic involvement. We present a patient with B-symptoms and diffuse lymphadenopathy who was diagnosed with the infrequently described nodal anthracosis. A 64year-old Vietnamese gentleman with a 50-pack-year smoking history who was recently diagnosed with prostate cancer post-radical prostatectomy and awaiting radiation therapy presented with generalized weakness, low-grade fever, night sweats, and unquantifiable weight loss for a month. He was hemodynamically stable, and examination revealed bilateral inguinal and axillary lymphadenopathy. Computed tomography (CT) showed diffuse lymphadenopathy involving the mediastinum, hilar, axillary, mesenteric, retroperitoneal, and bilateral iliac chains with multiple diffuse pulmonary nodules. Laboratories disclosed anemia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), albumin-globulin (A-G) reversal, and sterile blood cultures. The disseminated intravascular coagulation panel was negative with normal fibrinogen and mildly elevated D-dimer. Autoimmune workup, including antinuclear antibody (ANA), was negative. Infectious workup included Babesia, Ehrlichia, Anaplasma, Lyme serology, QuantiFERON-TB Gold, HIV, and hepatitis panel, and all were negative. He was managed with broad-spectrum antibiotics, which were discontinued after a negative infectious workup. He also complained of a new-onset holocranial headache with no features of meningitis; an MRI with contrast revealed focal occipital leptomeningeal involvement and cerebral edema with occipital lymphadenopathy. A lumbar puncture was planned but deferred at the patient's request. An excisional lymph node biopsy of the left axillary lymph node revealed reactive follicular hyperplasia with no evidence of malignancy, with flow cytometry negative for any evidence of B-or T-cell malignancies. He continued to have persistent low-grade fevers. A bone marrow biopsy showed 70% cellularity with paratrabecular interstitial lymphoid aggregates composed of both T and B cells, which was nonspecific, and flow cytometry could not be done due to dry tap. An F-18-fluorodeoxyglucose positron emission tomography (FDG PET) scan showed extensive hypermetabolic disease both above and below the diaphragm with bulky mediastinal adenopathy and splenomegaly. Subsequently, he underwent a mediastinoscopy and biopsy of the mediastinal lymph nodes, which demonstrated reactive hyperplasia and abundant anthracitic pigment on microscopic examination, consistent with the diagnosis of nodal anthracosis. He was managed conservatively, discharged, and found to have spontaneously resolved symptoms at a six-week follow-up. Nodal anthracosis with PET-positive mediastinal and hilar lymphadenopathy is a rare presentation of anthracosis that mimics infectious conditions, granulomatous diseases, and malignancies. The pigment deposition can cause persistent inflammatory...

show abstract

A retrospective observational study of benign anthracotic lymphadenitis and its association with PET avid lymph nodes in patients undergoing cancer evaluation

Cited by 5 publications

References 18 publications

Accuracy of endobronchial ultrasound‐guided transbronchial needle aspiration for staging of non‐small cell lung cancer

Accuracy of endobronchial ultrasound‐guided transbronchial needle aspiration for staging of non‐small cell lung cancer

Practical challenges in lung cancer pathology: bedside care to treatment decisions

The Curious Case of the Black Buboes

Contact Info

Product

Resources

About