Etiology of mediastinal lymph node enlargement in patients who underwent EBUS-TBNA

Dąbrowska, Marta; Faber, Katarzyna; Tandejko-Burdyna, Martyna; Korczyński, Piotr; Krenke, Rafał

doi:10.1183/13993003.congress-2019.pa3095

Cited by 3 publications

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“…Among the benign diseases, the most common was sarcoidosis (23.3%). [ 18 ] In our study, anthracotic LNs were found as the most frequent malady (35%). Among the total malignancies (29.5%), the number of lung cancers and extrapulmonary malignancies was found to be 24.5% and 4.9%, respectively.…”

Section: Discussionmentioning

confidence: 48%

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

Korkmaz¹,

Demirbaş²,

Vatansev³

2021

Medicine

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. Material and Method: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. Results: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ± 2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ± 7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. Conclusion: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.

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Section: Discussionmentioning

confidence: 48%

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

Korkmaz¹,

Demirbaş²,

Vatansev³

2021

Medicine

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“…Evison et al [ 17 ] reported that the size of hilar or mediastinal lymph node was the strongest predictor of etiology, with the size of 15 mm or less always reactive and the size of larger than 25 mm predict pathologic etiology. It is commonly found to be associated with malignant diseases, sarcoidosis, and heart failure[ 18 ]. Lymphoma is the most common cause of mediastinal lymphadenopathy.…”

Section: Mediastinal Lymphadenopathymentioning

confidence: 99%

Mediastinal lymphadenopathy in COVID-19: A review of literature

Taweesedt¹,

Surani

2021

WJCC

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A novel coronavirus disease 2019 (COVID-19) is a progressive viral disease that affected people around the world with widespread morbidity and mortality. Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal, cardiac, or neurological system dysfunction. Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation. Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies. It is commonly found to be associated with malignant diseases, sarcoidosis, and heart failure. Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection. We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection. Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

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“…Mediastinal lymphadenopathy, one of the CT findings, can be caused by benign or malignant disorders ( 15 ). Primary lung cancer, lymphoma, metastatic malignancies to the mediastinum from other sites, lymphomatoid granulomatosis (like sarcoidosis), interstitial lung disease, and infective etiologies such as pneumonia, pulmonary tuberculosis, pulmonary fungal infection, and thoracic histoplasmosis are the most common cause of mediastinal lymphadenopathy ( 16 , 17 ). Several studies have recently suggested that mediastinal lymphadenopathy (LAP) prevalence in patients with COVID-19 ranges from 3•4% to 5•4%, while its prevalence in patients with severe COVID-19 has been seen a sharp rise to 66% ( 14 , 18 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

Mediastinal lymphadenopathy and prognosis of COVID-19 disease

Pilechian¹,

Pirsalehi²,

Arabkoohi³

2021

IJM

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Background and Objectives: There are conflicting studies on the prevalence of mediastinal lymphadenopathy (LAP) and its relationship to the prognosis of COVID-19 disease. The prevalence varied from 3.4 to 66 percent and more prevalent in pa- tients who died. This study aimed to investigate the mediastinal lymphadenopathy and the disease progression in COVID-19 patients. Materials and Methods: In this case-control study, 195 COVID-19 patients were divided into two groups, with the medias- tinal lymphadenopathy and without it. In these groups, demographic characteristics, underlying diseases, laboratory results, and outcomes were compared. Results: The median age in the LAP group was higher than the opposite group (62 vs. 58.5; p= 0.037). SpO2 (85% vs. 90%; P <0.001), lymphocyte count (760 vs. 969; p= 0.02), Neutrophil-to-Lymphocyte Ratio (5.53 vs. 4.41; p= 0.02), and ESR (36 vs. 29; p= 0.03) were significantly correlated with the presence of lymphadenopathy, using the Mann-Whitney Wilcoxon rank test. ICU admission (65.71% vs. 36.87; p= 0.003), mechanical ventilation (31.42% vs. 13.75%; p= 0.022), disease se- verity (65.71% vs. 40%; p <0.01), length of hospital stay (9 vs. 7; p= 0.039) and mortality rate (40% vs. 21.25%; p= 0.034) were more predominantly observed in the LAP group, using the χ2 test. There was no apparent difference in sex and the underlying diseases among the two groups. Conclusion: This observation showed a relatively high prevalence of mediastinal lymphadenopathy in COVID-19 patients, which was more common in the elderly with low oxygen saturation. Therefore, LAP may lead to further intensive care needs, more use of mechanical ventilation, high severity of disease, and mortality rate.

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Etiology of mediastinal lymph node enlargement in patients who underwent EBUS-TBNA

Cited by 3 publications

References 0 publications

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

Mediastinal lymphadenopathy in COVID-19: A review of literature

Mediastinal lymphadenopathy and prognosis of COVID-19 disease

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