Mediastinal lymph node staging by EBUS-TBNA and CT: Characteristics of lymph node enlargement caused by anthracosis and other benign conditions

Kirchner, Johannes; Broll, Michael; Müller, Philipp; Kirchner, Esther Maria; Pomjanski, Natalia; Biesterfeld, Stefan; Liermann, D.; Kickuth, Ralph

doi:10.5430/ijdi.v1n2p64

Cited by 3 publications

(6 citation statements)

References 32 publications

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“…Endobronchial ultrasound–TBNA is a useful procedure in the identification of anthracotic particles. 6 Kirchner et al 7 examined mediastinal lymph nodes with EBUS–TBNA. Then, the anatomical positions of these lymph nodes were analyzed by multislice computed thorax tomography, and they found that the foremost common location of anthracotic lymph nodes was the subcarinal.…”

Section: Discussionmentioning

confidence: 99%

Granulomatous Mediastinitis: A Rare Cause of Pulmonary Hypertension

Ozturk Sahin,

Galata,

Demir

et al. 2023

Thoracic Research and Practice

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A rare case of a patient with chronic obstructive pulmonary disease who developed secondary anthracofibrosis to biomass exposure, fibrosing mediastinitis due to anthracotic enlarged lymph nodes in the mediastinum, and pulmonary hypertension because of compression of the lymph nodes on the pulmonary arteries is presented. This is a case report of a 71-year-old female patient who has been followed up with chronic obstructive pulmonary disease for 10 years, has no history of smoking, and has been exposed to biomass for many years. The patient, who had been hospitalized in various centers for the last 3 years due to progressive shortness of breath and dry cough, applied to us with dry cough and dyspnea complaints. On echocardiography, systolic pulmonary arterial pressure was found to be 59 mmHg. For the etiology of pulmonary hypertension, dual-energy thoracic computed tomography was performed with the suspicion of chronic thromboembolic pulmonary hypertension. No filling defect compatible with thromboembolism was detected. In right heart catheterization, mean pulmonary artery pressure was 27 mmHg, pulmonary capillary tip pressure was 7 mmHg, and pulmonary vascular resistance was 3.71 woods units. Endobronchial ultrasound was applied to the patient with the preliminary diagnoses of lymphoma, anthracosis, fibrosing mediastinitis, and infection. Widespread anthracosis was observed in all lobes and segments macroscopically. The lymph node in the subcarinal area was interpreted as anthracotic lymph node. Anthracosis is defined as black pigmentation involving the mucosal, and submucosal layers of the tracheobronchial tree and the lung parenchyma. If anthracosis is associated with luminal obliteration and/or mucosal proliferation causing obstruction, it is considered anthracofibrosis. In this case, we saw that secondary anthracofibrosis, fibrosing mediastinitis due to anthracotic enlarged lymph nodes in the mediastinum, and pulmonary hypertension may develop because of compression of the lymph nodes on the pulmonary arteries, and we wanted to draw attention to it was a rare case.

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Section: Discussionmentioning

confidence: 99%

Granulomatous Mediastinitis: A Rare Cause of Pulmonary Hypertension

Ozturk Sahin,

Galata,

Demir

et al. 2023

Thoracic Research and Practice

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“…In the literature, according to the ATS regional lymph node system, the most studied lymph node was subcarinal, with rates of 36%, 39%, and 41.5% in some previous studies [ 14 , 5 , 6 ]. In our study, the most frequently examined lymph node with a rate of 37% was subcarinal and this was consistent with the literature data.…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Kirchner et al, they compared anthracosis and other benign diseases, and they found no difference in size [ 6 ]. In another study by Kirchner et al, they took the malignant patient group and the control group as the anthracosis and found that the lymph nodes of the anthracosis group were smaller [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Anthracosis can cause difficulties in patients being evaluated for malignancy. In the literature, some studies tried to determine the radiological features of the anthracosis structure in the mediastinal and hilar lymph nodes with thorax CT [ 5 , 6 ]. In addition, malignancy was detected in some anthracotic lymph nodes after at least one-year follow-up or surgical removal.…”

Section: Introductionmentioning

confidence: 99%

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The Differentiation of Metastatic Mediastinal Lymph Nodes From Benign Hypermetabolic Lesions

Bulut¹,

Çelik²,

Karamanli³

et al. 2022

Cureus

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Background Anthracosis may cause a positron emission tomography/computed tomography (PET/CT) false positivity in mediastinal and hilar lymph nodes. We aimed to evaluate the radiological features and the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes with anthracosis or squamous cell lung cancer metastasized. Methodology Patients diagnosed with anthracosis or squamous cell lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between January 1, 2015, and November 15, 2020, in a tertiary hospital were enrolled. The squamous cell subtype of lung cancer was selected due to its association with tobacco use, biomass, and air pollution. Anthracosis may occur due to the same etiologic reasons. Results A total of 190 patients met the study enrollment criteria, of which 86 were diagnosed with anthracosis and 33 with squamous cell lung cancer lymph metastasis. Median values for short axis, long axis, SUVmax, shape features, and presence of calcification were found significantly different between the groups. In receiver operating characteristic (ROC) analysis, the SUVmax cut-off value was calculated as 6.61. With this cutoff value, the negative predictive value (NPV) was 92.5% and the positive predictive value (PPV) was 54% for differentiating anthracosis and malignant lymph nodes metastasis. Conclusions We conclude that the evaluation of the shape and metabolic activities of the anthracotic lymph nodes detected by PET/CT together with EBUS-TBNA granted a more accurate staging of the patients and more cancer patients will benefit from surgical treatment.

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“…Previous studies have shown hilar or mediastinal lymphadenopathy in 94% of subjects, of which 57% were calcified, pursued by bronchial stenosis and narrowing, with or without atelectasis in 94% of the cases [7]. The enlarged mediastinal lymph nodes recorded by CT are also observed in the majority of patients with this problem; however, this evidence may also appear in those suffering from metastatic lung cancer, sarcoidosis, chronic heart failure, or pneumoconiosis [8,9]. Herein, we evaluate the significance of high attenuated, non-calcified mediastinal and hilar lymph nodes in the diagnosis of anthracosis, and we define the triad of anthracosis with high specificity for diagnosis of anthracosis.…”

Section: Introductionmentioning

confidence: 98%

Diagnostic triad of pulmonary anthracofibrosis in spiral CT scan – a retrospective study

Kahkouee¹,

Khabbaz²,

Keshavarz³

et al. 2019

Pol J Radiol

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Purpose Anthracosis, a form of pneumoconiosis commonly caused by air pollution and other environmental factors, is a new entity in respiratory disorders. Bronchoscopy and transbronchial lung biopsy (TBLB) are the gold standard of diagnosis. Herein, we evaluated the results of bronchoscopy and chest computed tomography (CT) scans of 187 anthracotic patients. Material and methods Between April 2016 and April 2017, 187 cases (99 males, mean age 65 ± 10.2 years) who underwent flexible bronchoscopy and TBLB for various indications were considered for this study. CT examinations of these patients were reported as “blind to bronchoscopy results” by two experienced board-certified radiologists. Results According to the results of bronchoscopy and TBLB, 100 patients were diagnosed as anthracotic. CT scans confirmed 71 of these cases as anthracosis. Sensitivity, specificity, PPV, NPV, and accuracy of hyperdense non-calcified mediastinal and hilar lymph nodes, known as “brilliant lymph nodes”, compared to bronchoscopy were 55%, 92%, 89%, 64%, and 72%, respectively (CI: 95%). Also, there was a positive correlation between anthracosis and brilliant lymph nodes (p-value = 0). Analysis of hyper-attenuated lung with bronchoscopy estimated sensitivity, specificity, PPV, NPV, and accuracy gave 41%, 94%, 89%, 58%, and 65%, respectively (CI: 95%). The specificity of brilliant lymph nodes, hyper-attenuated lung, and multi-segmental atelectasis as a diagnostic “triad of anthracosis” was 100%. Conclusions Based on our analyses, the triad of brilliant lymph nodes, hyper-attenuated lung, and multi-segmental atelectasis was identified as a reliable set of imaging findings for the diagnosis of anthracosis.

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Mediastinal lymph node staging by EBUS-TBNA and CT: Characteristics of lymph node enlargement caused by anthracosis and other benign conditions

Cited by 3 publications

References 32 publications

Granulomatous Mediastinitis: A Rare Cause of Pulmonary Hypertension

Granulomatous Mediastinitis: A Rare Cause of Pulmonary Hypertension

The Differentiation of Metastatic Mediastinal Lymph Nodes From Benign Hypermetabolic Lesions

Diagnostic triad of pulmonary anthracofibrosis in spiral CT scan – a retrospective study

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