Prevalence of enlarged mediastinal lymph nodes in heavy smokers—a comparative study

Kirchner, Johannes; Kirchner, Esther Maria; Goltz, Jan Peter; Lorenz, Vivian-Wilma; Kickuth, Ralph

doi:10.1007/s00330-011-2111-9

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…Non-specific signs such as fever, weight loss, and decreased energy are shared by common IMHL differentials such as sarcoidosis, tuberculosis, lymphoma, and malignant carcinoma. Adding to the diagnostic dilemma, reactive lymphocytosis is associated with prevalent chronic diseases such as chronic obstructive lung disease [1], interstitial lung disease [2], and congestive heart failure [3,4]. Therefore, patients with IMHL often require an invasive procedure to obtain tissue for cytohistologic and microbiologic assessment.…”

Section: Introductionmentioning

confidence: 99%

Performance of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Isolated Mediastinal and Hilar Lymphadenopathy

Tyan¹,

Machuca²,

Czarnecka³

et al. 2017

Respiration

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Background: Although many studies have assessed the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the context of a specific disease, few studies have assessed the overall diagnostic yield, sensitivity, and negative predictive value in patients with isolated mediastinal and hilar lymphadenopathy (IMHL). Objective: We evaluated the performance of EBUS-TBNA for diagnosing IMHL in a population with a high prevalence of concurrent or preexisting non-pulmonary malignancy. Methods: A retrospective chart review of patients who underwent EBUS-TBNA from October 2008 to April 2014 was performed to identify patients with IMHL. Patients with known or suspected primary pulmonary malignancy were excluded. When available, EBUS-TBNA results were cross-referenced with further diagnostic investigation or clinical diagnosis based on follow-up. Results: EBUS-TBNA was used to sample 765 lymph nodes from 350 patients. One hundred and fourteen (33.3%) patients had a concurrent or preexisting non-pulmonary malignancy. The overall yield of EBUS-TBNA for specific diagnosis was 300/350 (86%). The diagnostic yield for sarcoidosis, lymphoproliferative disease, metastatic lymphadenopathy from extrathoracic malignancy, and necrotizing granuloma was 123/149 (83%), 27/33 (82%), 20/25 (80%), and 13/19 (68%), respectively. Amongst 50 patients with non-diagnostic EBUS-TBNA, 25 yielded an insufficient sample and another 25 yielded only benign lymphoid material which was not representative of the underlying pathology. Overall, EBUS-TBNA had a sensitivity of 89%, a diagnostic yield of 86%, and a negative predictive value of 79%. Conclusion: For patients with isolated hilar or mediastinal lymphadenopathy and a high background prevalence of concurrent and preexisting non-pulmonary malignancy, EBUS-TBNA is a reliable first-line diagnostic investigation.

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Section: Introductionmentioning

confidence: 99%

Performance of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Isolated Mediastinal and Hilar Lymphadenopathy

Tyan¹,

Machuca²,

Czarnecka³

et al. 2017

Respiration

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“…Anthracosis is a form of pneumoconiosis which is not only caused by coal dust but also other environmental factors such as air pollution, biomass fuels used extensively for cooking ("hut lung"), and cigarette smoking [9,[16][17][18][19] . A recently published comparative study on 44 heavy smokers and 44 non-smokers demonstrated that enlarged mediastinal lymph nodes may occur in up to 52% of heavy smokers, especially in those with severe bronchitis [9] .…”

Section: Discussionmentioning

confidence: 99%

“…A recently published comparative study on 44 heavy smokers and 44 non-smokers demonstrated that enlarged mediastinal lymph nodes may occur in up to 52% of heavy smokers, especially in those with severe bronchitis [9] . The authors of that study assumed that lymph node enlargement in smokers may be caused by a deposition of anthracotic material and dust induced response.…”

Section: Discussionmentioning

confidence: 99%

“…While the occurrence of enlarged calcified mediastinal lymph nodes has been generally accepted as a sign of pneumoconiosis in coal workers [6] , to date -perhaps as a result of the decline of the coal mining and steel industries in the western countries -less attention has been paid to the impact of dust on mediastinal lymph node staging in cancer patients. Since anthracosis is a form of pneumoconiosis not only caused by occupational exposition to coal dust, but also by cigarette smoking and environmental pollution [9] radiologists should be aware of mediastinal lymph node enlargement also in these conditions. Aim of this comparative study was to demonstrate the findings of EBUS-TBNA and chest CT in benigne enlarged mediastinal lymph nodes due to anthracosis, lymphadenopathy and sarcoidosis and to assess the impact of both methods for mediastinal lymph node staging in cases of lymph node enlargement due to these benign conditions.…”

Section: Introductionmentioning

confidence: 99%

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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

Kirchner

Broll

Müller

et al. 2014

IJDI

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Objectives: Aim of this comparative study was to assess the accuracy of computed tomography (CT) and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lymph node staging in cases of lymph node enlargement due to anthracosis and other benign conditions. Methods:In a retrospective analysis we report on the MSCT findings of 39 patients (28 males, 11 females) with EBUS-TBNA confirmed diagnosis of 53 enlarged lymph nodes due to anthracosis. A control group comprised 20 consecutive patients with 27 enlarged lymph nodes (11 males, 9 females) due to chronic lymphadenopathy (n = 14) or sarcoidosis (n = 13).Results: No significant differences were observed between the two groups regarding size (mean short axis diameter 13.7mm vs. 14.5mm), shape (most often oval) or presence of lymph node confluence (32.1% vs. 33.3%), contrast enhancement (3.8% vs. 3.7%), and fatty involution (3.8% vs. 3.7%). In comparison with the control group anthracotic lymph nodes were significantly less often ill-defined in EBUS (5.7 vs. 25.9, p = 0.025) as well as in CT (1.9% vs. 18.5%, p = 0.01), but more often showed calcifications in CT (24.5% vs. 3.7%, p = 0.017). Lymph node colliquation was seen neither in anthracosis nor in other benign conditions. Conclusions:Mediastinal lymph node enlargement due to anthracosis, lymphadenopathy and sarcoidosis show some different findings in EBUS and CT but cannot definitely be differentiated. Advances in knowledge:Radiologists should be aware of mediastinal lymph node enlargement due to anthracosis.

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“…1 It is characterised by formation of black nodules on the bronchioles, focal emphysema, and the deposition of coal dust in lymph nodes ( Figure 1). 2 Since anthracosis is a form of pneumoconiosis not only caused by the occupational exposure to coal dust (coal workers pneumoconiosis), but also by cigarette smoking and environmental pollution, 3 radiologists should be aware of mediastinal lymph node enlargement occurring in these conditions, as this fact may impact staging of malignant lung diseases per se. To our knowledge, computed tomography (CT) appearance of histologically proven lymph node anthracosis has not been substantially addressed in the literature so far.…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Anthracosis of Mediastinal Lymph Nodes: Correlation with Computed Tomography Findings

Kirchner¹,

Broll²,

Murach³

et al. 2014

Hong Kong J Radiol

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Objectives: To demonstrate the computed tomography findings of endobronchial ultrasound-guided transbronchial needle aspiration-proven hilar and mediastinal lymph node anthracosis. Methods: We retrospectively studied the computed tomography (multislice computed tomography, 64 x 0.75 mm slice collimation, tube voltage 120 kV) findings in 49 patients (37 males, 12 females) with endobronchial ultrasound-guided transbronchial needle aspiration-confirmed diagnosis of 89 anthracotic lymph nodes. Results: Overall, 58.4% of the cytologically proven anthracotic lymph nodes showed enlargement with a mean short axis diameter of 11.1 mm (range, 5-23 mm). The majority of the anthracotic lymph nodes were oval (86.5%), 7.9% were round, and 5.6% were polycyclic in shape. Confluence of anthracotic lymph nodes was seen in 28.1% of the lymph nodes, and patchy hyperdensities-like calcifications were observed in only 18.0%; none of the lymph nodes showed necrosis. Conclusion: Lymph node anthracosis often results in enlargement of hilar and mediastinal lymph nodes.

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Prevalence of enlarged mediastinal lymph nodes in heavy smokers—a comparative study

Abstract: The present study demonstrates that enlarged mediastinal lymph nodes may occur in a rather high percentage of heavy smokers, especially in those with a MDCT finding of severe bronchitis.

Cited by 13 publications

References 28 publications

Performance of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Isolated Mediastinal and Hilar Lymphadenopathy

Performance of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Isolated Mediastinal and Hilar Lymphadenopathy

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

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Anthracosis of Mediastinal Lymph Nodes: Correlation with Computed Tomography Findings

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