Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT.

Bankoff, Mark S.; McEniff, Niall; Bhadelia, Rafeeque A.; Garcia-Moliner, Maria; Daly, Benedict D.T.

doi:10.2214/ajr.167.3.8751667

Cited by 63 publications

(33 citation statements)

References 7 publications

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“…In one study of patients in the NELSON Lung Cancer Screening Trial, 20% of nodules were classified as perifissural, and 16% of these grew during the study; however, none were malignant (94). However, perifissural or juxtapleural location does not in itself reliably indicate benignancy, and the specific nodule morphology must be considered (95,96). A spiculated border, displacement of the adjacent fissure, or a history of cancer increase the possibility of …”

Section: Perifissural Nodulesmentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given. detected at CT in adult patients who are at least 35 years old. Separate guidelines have been issued for lung cancer screening, such as those from the American College of Radiology (ACR), and we support the use of those guidelines when interpreting the results of CT screening (8). Specific recommendations are provided for patients with multiple solid and subsolid nodules, and several other commonly encountered clinical situations are addressed.These guidelines are not intended for use in patients with known primary cancers who are at risk for metastases, nor are they intended for use in immunocompromised patients who are at risk for infection; in these patients, treatment should be based on the specific clinical situation. Also, because lung cancer is rare in children and adults younger than 35 years, these guidelines are no...

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Section: Perifissural Nodulesmentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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“…In addition, there has been an increasing number of reports regarding intrapulmonary lymph nodes on CT scans (13～17). The previously reported prevalence of intrapulmonary lymph nodes in patients who had small (less than 12 mm) pulmonary nodules and underwent surgery was 18～46% (13,14). Therefore, there is a need to be aware of the intrapulmonary lymph nodes as a common cause of small pulmonary nodules.…”

Section: Current Issues 1) False Positive Resultsmentioning

confidence: 99%

Lung Cancer Screening with Low-Dose Chest CT: Current Issues

Ahn

2004

Cancer Res Treat

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C om pute d tom ogra phy offers m a ny advanta ges over routine radiogra phs in screening for lung cancer, and it is cle a r tha t low-dose spira l C T scre e ning ca n m ore fre que ntly find conside ra bly sm a lle r lung ca nce rs tha n pre vious de te ction tools. R e ce ntly, inve stiga tors ha ve pe rform e d low-dose spira l C T scanning for scre ening of lung cancer, and have suggested that C T screening can depict lung cancers at smaller sizes and at earlier stages. W ith te chnologica l a dvances in spira l C T scanners, the de tection rate of sm all nonca lcified pulm onary nodules ha s m a rke dly incre a se d, with highe r ra te s note d with thinne r collim a tion of C T sca nning. U nfortuna te ly, the m a jority of the se ha ve prove d to be be nign, i.e . fa lse positive re sults. If, e ve n in part, C T fe a ture s could be found to pre dict be nign nodule s without follow-up, the false -positive ra te would be reduced, and conse que ntly, the cost, em otional stress, radiation dose, m orbidity and m orta lity a ssocia te d w ith inte rve ntiona l proce dure s would also be reduced. There have been several studies trying to establish reliable C T features for benign lesions in sm a ll pulm ona ry nodule s a nd to de te rm ine the ir outcom e . Although the se e fforts ha ve not com ple te ly resolved the issue of false positive results, it is expected that lessons will be learnt on how to manage these small nodules through e xperie nce with scre ening in the nea r future. Because pulmonary nodules on C T are much more common in Korea than in western countries, the management algorithm for screening C T-detected nodules should be m odified a ccording to diffe rent circum stances, with conse nsus am ong related physicians and radiologists. In a ddition, to e nha nce pa tient care and a void m isunde rsta nding of inhe re nt lim ita tion of C T scre e ning by the screening subjects, physicians, hospital managers as well a s radiologists should provide proper inform a tion re garding C T screening to the screenees.

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“…Due to the increasing use of CT and high-resolution CT (HRCT) in general investigations of pulmonary problems, the differential diagnosis of previously undetected small pulmonary nodules has become more important. One larger study by BANKOFF et al [2] evaluated the prevalence of IPLN and assessed their appearance on CT. The study demonstrated that they are discovered frequently in patients who undergo mini-thoracotomies for the evaluation of pulmonary nodules detected by CT, as in the current patient.…”

Section: Diagnosis: Intrapulmonary Lymph Nodes (Ipln)mentioning

confidence: 99%

“…Most IPLN are uncalcified, well circumscribed, round or oval, and located in the lower lobes in the subpleural space. They are found more frequently in males and smokers [2][3][4][5]. These findings are different from intrapulmonary calcifications following varicella [6].…”

Section: Diagnosis: Intrapulmonary Lymph Nodes (Ipln)mentioning

confidence: 99%

A young female with fatigue and dyspnoea

Tobler

Barghorn²,

Steurer-Stey³

2004

Eur Respir J

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A 25-yr-old female was admitted to hospital due to fatigue and dyspnoea for a duration of 3 months. Difficulty in breathing occurred during physical activity and in stressful situations, but also sometimes during bed rest, and was associated with the feeling of palpitations. The patient smoked 30 cigarettes?day -1 (total 8 pack-yrs) and took no medication. The patient9s personal and family history was uneventful. There was no recent history of travelling. She worked as a clerk and noticed no change in symptoms at work or over the weekends.The patient was overweight (body mass index 31.5 kg?m -2 ) and had a normal body temperature on clinical examination. Her blood pressure was 120/80 mmHg, heart rate 76 beats?min . No crackles were heard during auscultation. The blood tests showed no abnormalities, specifically no anaemia nor inflammatory signs. A chest radiograph and ECG were performed, and showed normal results. Pulmonary function tests demonstrated normal static and dynamic lung volumes, but a mild reduction in diffusing capacity (70% predicted). A computed tomography (CT) of the chest was performed because of the smoking history and the reduced diffusion capacity ( fig. 1).Serological tests for HIV and systemic vasculitic diseases were negative. The tuberculin test showed no reaction. Metastatic disease of the lung was suspected and a search for a primary tumour was commenced. Skin and retina showed no suspicious lesions regarding melanoma. A gynaecological examination, including mammography and ultrasound of the breasts, showed normal results, as well as ultrasounds of the thyroid and abdomen.The patient, who was afraid of having a malignant tumour, asked for a second opinion and was admitted to the authors9 clinic. The differential diagnoses included metastases, infectious, inflammatory or granulomatous lung diseases. Due to the lack of diagnosis from noninvasive diagnostic procedures, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was discussed prior to video-assisted thoracoscopy. However, the patient requested a straightforward approach with the highest chance of diagnosis and, therefore, a video-assisted thoracoscopic wedge resection with histopathological examination of a subpleural nodule of the right lower lobe was performed (figs 2-4).

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Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT.

Cited by 63 publications

References 7 publications

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

Lung Cancer Screening with Low-Dose Chest CT: Current Issues

A young female with fatigue and dyspnoea

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