Utility of minimally invasive thoracoscopy for assessment of residual mediastinal lymphoma

Abstract

A large proportion of patients with residual positron emission tomography-avidity after first-line chemotherapy of mediastinal lymphomas have residual disease that can be detected safely using minimally invasive thoracoscopy.

Comparison between diffusion-weighted magnetic resonance and positron-emission tomography in the evaluation of treated lymphomas with mediastinal involvement

“…Our results are in accord with those found in a recent review reporting a proportion of false-positive results ranging from 7.7 to 90.5% among all biopsied FDG-avid lymphoma at 18 F-FDG PET-CT performed during or after completion of treatment [15]; therapy-induced inflammatory changes are considered the mainly responsible of these results [15,16]. According to Novo et al [13], a DS of 3 and 4 may be ambiguous and unreliable in predicting persistent disease in mediastinal residual mass after therapy, as 50% of biopsies that they performed in these cases were negative.…”

“…The persistent high metabolism in treated residual masses is mainly related to inflammatory changes and necrosis induced by treatments [14][15][16]; in case of radiotherapy, metabolic alterations may persist up to 3-4 months, precluding a precise determination as to the neoplastic nature of the residual tissue [17]. Moreover, the presence of mediastinal structures, as thymic hyperplasia or thymic regrowth following chemotherapy in young adults, can easily confuse the residual neoplastic tissue evaluation [16,18].…”

“…The detection of residual disease in anterior mediastinal lymphomas is a pivotal issue because it has important therapeutic implications. To now, mediastinal biopsy remains the gold standard to establish definitive diagnosis [7,8,16,18]. However, biopsies are reported to have low diagnostic accuracy due to the heterogeneity of the residual tissue after treatment composed of inflamed and fibrotic tissue [19].…”