Risk factors and maximum standardized uptake values within lymph nodes of anthracosis diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

Abstract

Background/aim: Enlarged mediastinal lymph nodes can result from serious etiologies including granulomatous disease, neoplasia, etc., and a rare condition called anthracosis . The aim of this study was to determine the incidence of risk factors and the uptake values within the anthracotic lymph nodes.Materials and methods: 106 patients who underwent endobronchial ultrasound transbronchial needle aspiration and were diagnosed as having anthracosis were analyzed retrospectively. Patients with positive confirmation by surgical biopsies or a 1-year follow-up period were enrolled.Results: 201 lymph nodes were sampled from 106 patients. Subcarinal and interlobar lymph nodes were the most commonly affected stations (36.8% and 34.3%, respectively). The mean durations of exposure to biomass and cigarette smoke were 35.5 and 33 years, respectively. The mean maximum standardized uptake value (SUVmax) within the lymph nodes was 4.76. The SUVmax of the patients with associated malignancy was 4.19 and the SUVmax of nonmalignant patients was 5.28. This difference was statistically significant (P = 0.009). Conclusion:These findings suggest that anthracosis also affects the mediastinal and hilar stations; it should be considered in differential diagnosis in patients with mediastinal and hilar lymphadenopathies with intense uptake on positron emission tomography scans, especially when there is a history of exposure to known risk factors.

Granulomatous Mediastinitis: A Rare Cause of Pulmonary Hypertension

“…Some studies have reported increased FDG uptake in PET scans in anthracotic lymph nodes in the mediastinum. 5 In a study by Yilmaz Demirci et al 3 , the mean SUVmax value was reported as 4.76 (1-16.8) in anthracosis sampled lymph nodes. As a result, if there is a history of exposure to hazards and noxious particles, the possibility of a benign condition ought to be considered when serious uptake in mediastinal and hilar lymph nodes is observed in a PET scan.…”

“…Anthracosis is also one of the common reasons for enlarged mediastinal lymph nodes in developing countries. 3 Anthracotic mediastinal lymph nodes often appear oval, with calcification. Sclerosing mediastinitis or mediastinal fibrosis terms are also used for “Fibrous mediastinitis.” In addition, it has been defined an as “idiopathic fibro-inflammatory lesion.” Even though the etiology has not been fully clarified, factors such as tuberculosis, aspergillosis, mucormycosis, blastomycosis, cryptococcosis, and anthracosis have been reported in the etiology of fibrous mediastinitis.…”

“…Anthracotic enlarged mediastinal lymph nodes were investigated in other cases for malignancy and granulomatous infections. 3 Because of the pathological FDG uptake in PET scans, we wanted to rule out, especially malignancy or tuberculosis, no findings were noted for these possibilities in the histopathological investigation. Fluorodeoxyglucose can accumulate in inflammatory cells such as activated macrophages and neutrophils at the location of inflammation or infection.…”

The Differentiation of Metastatic Mediastinal Lymph Nodes From Benign Hypermetabolic Lesions

“…The mean SUVmax value of the patients with associated malignancy was 4.19 and the mean SUVmax of nonmalignant patients was 5.28. They found SUVmax values high in the group with anthracosis [ 15 ]. In their study, Köksal et al examined SUVmax values of metastatic, anthracotic, and reactive lymph nodes, which became definite after lymph node dissection in resected non-small cell carcinoma (NSCC) cases.…”

Etiología de falsos positivos del 18F-FDG PET-CT de ganglios mediastinales e hiliares con biopsia quirúrgica en pacientes oncológicos

“…Por último, Saydam y colaboradores reportaron que la sensibilidad y especificidad de la estadificación mediastinal de pacientes trabajadores en minas de carbón con cáncer de pulmón de célula no pequeña (14,15,16), sea una entidad a tener en cuenta en los pacientes con era de 75% y 90%, respectivamente. Además, concluyó que el 18F-FDG PET-CT es insuficiente para la estadificación mediastinal en estos trabajadores por la alta tasa de falsos positivos debido a la presencia de neumoconiosis (17).…”