Intrapulmonary lymph nodes in South African miners—an autopsy survey

Honma, Koichi; Nelson, Gill; Murray, Jill

doi:10.1002/ajim.20436

Cited by 11 publications

(11 citation statements)

References 11 publications

(17 reference statements)

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“…Some of these guidelines also describe the entity of benign intrapulmonary lymph nodes (IPLNs), for which further follow-up or investigation is not recommended (3,4,6). Over the past 3 decades, increasing numbers of studies have pathologically confirmed that some pulmonary nodules seen at CT are IPLNs (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). An autopsy survey of 2337 South African miners revealed an IPLN prevalence of 3.7%, although this was considered a minimum estimate (16).…”

mentioning

confidence: 99%

“…Over the past 3 decades, increasing numbers of studies have pathologically confirmed that some pulmonary nodules seen at CT are IPLNs (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). An autopsy survey of 2337 South African miners revealed an IPLN prevalence of 3.7%, although this was considered a minimum estimate (16). CT studies have also demonstrated the negligible risk of malignancy in nodules typical for IPLNs.…”

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confidence: 99%

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Classification of CT Pulmonary Opacities as Perifissural Nodules: Reader Variability

Schreuder¹,

Ginneken²,

Scholten³

et al. 2018

Radiology

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Purpose To study interreader variability for classifying pulmonary opacities at CT as perifissural nodules (PFNs) and determine how reliably radiologists differentiate PFNs from malignancies. Materials and Methods CT studies were obtained retrospectively from the National Lung Screening Trial (2002-2009). Nodules were eligible for the study if they were noncalcified, solid, within the size range of 5 to 10 mm, and scanned with a section thickness of 2 mm or less. Six radiologists classified 359 nodules in a cancer-enriched data set as PFN, non-PFN, or not applicable. Nodules classified as not applicable by at least three radiologists were excluded, leaving 316 nodules for post-hoc statistical analysis. Results The study group contained 22.2% cancers (70 of 316). The median proportion of nodules classified as PFNs was 45.6% (144 of 316). All six radiologists uniformly classified 17.7% (56 of 316) of the nodules as PFNs. The Fleiss κ was 0.50. Compared with non-PFNs, nodules classified as PFNs were smaller and more often located in the lower lobes and attached to a fissure (P < .001). Thirteen (18.6%) of 70 cancers were misclassified 21 times as PFNs. Individual readers' misclassification rates ranged from 0% (0 of 125) to 4.9% (eight of 163). Of 13 misclassified malignancies, 11 were in the upper lobes and two were attached to a fissure. Conclusion There was moderate interreader agreement when classifying nodules as perifissural nodules. Less than 2.5% of perifissural nodule classifications were misclassified lung cancers (21 of 865) in this cancer-enriched study. Allowing nodules classified as perifissural nodules to be omitted from additional follow-up in a screening setting could substantially reduce the number of unnecessary scans; excluding perifissural nodules in the upper lobes would greatly decrease the misclassification rate.

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confidence: 99%

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confidence: 99%

Classification of CT Pulmonary Opacities as Perifissural Nodules: Reader Variability

Schreuder¹,

Ginneken²,

Scholten³

et al. 2018

Radiology

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“…3,4 There is evidence that lymph node silicosis precedes lung silicosis. [5][6][7][8] Further, if silicosis occurs only in the lymph nodes, the clearance by macrophages might have been effective but only under low exposure levels. We therefore investigated the relative occurrence of silicosis by site (lung or lymph nodes only) and in association with exposure to quartz dust in German uranium miners with lung cancer.…”

Section: Commentmentioning

confidence: 99%

“…The study base is 14 times larger than that of the former feasibility study 10,11 and almost twice as large as a study in South African miners. 5 Whereas in the feasibility study the slides of lung and non-lung cancer cases were sent to the United States and were each examined independently by 4 pathologists, in our study only lung cancer cases were examined and evaluated independently by 3 German pathologists. Accordingly, differences in the histopathology analysis protocols exist.…”

Section: Commentmentioning

confidence: 99%

“…These studies found more quartz in lymph nodes than in the lung 3,4 and came to the conclusion that silicosis in lymph nodes precedes lung silicosis. [5][6][7][8] The underlying mechanism might be the lymphotropic nature of quartz 3 or that silica-laden macrophages may induce inflammatory or fibrogenic reactions of the mediastinal lymph nodes, the interstitium, and alveoli 6,9 or that the lymphatic clearance of fibrotic lymph nodes may be disturbed. 8 A preceding article 10 provided results on silicosis in lymph nodes and in the lung from a feasibility study 11 on 302 former miners from the autopsy repository of the German uranium miners.…”

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Association Between Lymph Node Silicosis and Lung Silicosis in 4,384 German Uranium Miners With Lung Cancer

Taeger

Brüning

Pesch

et al. 2011

Archives of Environmental & Occupational Health

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This study investigates the association between lymph node-only and lung silicosis in uranium miners with lung cancer and exposure to quartz dust. Tissue slides of 4,384 German uranium miners with lung cancer were retrieved from an autopsy archive and reviewed by 3 pathologists regarding silicosis in the lungs and lymph nodes. Cumulative exposure to quartz dust was assessed with a quantitative job-exposure matrix. The occurrence of silicosis by site was investigated with regression models for exposure to quartz dust. Miners with lung silicosis had highest cumulative quartz exposure, followed by lymph node-only silicosis and no silicosis. At a cumulative quartz exposure of 40 mg/m(3) × years, the probability of lung silicosis was above 90% and the likelihood of lymph node-only silicosis and no silicosis do not differ anymore. The results support that lymph node silicosis can precede lung silicosis, at least in a proportion of subjects developing silicosis, and that lung silicosis strongly depends on the cumulative quartz dose.

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Intrapulmonary lymph nodes: computed tomography findings with histopathologic correlations

et al. 2013

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Intrapulmonary lymph nodes in South African miners—an autopsy survey

Abstract: IPLNs are not uncommon among dust-exposed individuals. Silicotic fibrosis of IPLNs appears to precede pulmonary parenchymal disease.

Cited by 11 publications

References 11 publications

Classification of CT Pulmonary Opacities as Perifissural Nodules: Reader Variability

Classification of CT Pulmonary Opacities as Perifissural Nodules: Reader Variability

Association Between Lymph Node Silicosis and Lung Silicosis in 4,384 German Uranium Miners With Lung Cancer

Intrapulmonary lymph nodes: computed tomography findings with histopathologic correlations

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