Patterns of Lymphadenopathy in Thoracic Malignancies

Abstract

There are different lymphatic drainage pathways in the thorax that are relevant in the staging of lung cancer, breast cancer, lymphoma, esophageal cancer, and malignant mesothelioma. To properly search for metastatic spread, it is important to carefully evaluate the specific nodal stations that drain the thoracic structures from which a primary tumor originates. Because size criteria have limitations in the prediction of nodal status, pathologic confirmation is essential for accurate staging. Computed tomography (CT) is useful in helping the surgeon or interventional radiologist determine the most appropriate approach for nodal sampling. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has an increasing role in detection of diseased lymph nodes that appear normal at CT alone, particularly when FDG PET images are fused with CT images. However, the role of radiologic imaging extends beyond initial staging and the guidance of interventions to include posttreatment assessment and the detection of recurrent disease. Therefore, at all levels of cancer imaging, it is essential to identify the relevant lymph node regions and their relations to the primary tumor.

Unilateral vocal cord palsy as the presentation of metastatic mediastinal adenocarcinoma

“…More commonly, the lesion is a secondary metastasis from lung, gastrointestinal tract, pancreas, kidney or even the pituitary gland 3 . It is difficult to differentiate mediastinal adenocarcinoma from lymphoma based on CT findings alone as both of these conditions could present similar with anterior mediastinal mass with cervical lymphadenopathies [8][9][10] . This condition is seen in the indexed case.…”

Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

“…[ 18 F] FDG-PET has been proven more accurate than CT for the differentiation between intrathoracic benign and malignant lesions (Sharma et al, 2004; Brigid et al, 1997). However, certain physiologic or benign pathologic conditions would be mistaken for cancer on FDG-PET images.…”

Imaging the posterior mediastinum: a multimodality approach

“…The only widely accepted criterion suggestive of malignancy is a short-axis node diameter greater than 10 mm (56,57). However, this approach may result in both false positives and false negatives, due to inflammatory nodal enlargement and the presence of metastases in normal-sized lymph nodes, respectively.…”