Validity of Enlarged Mediastinal Nodes as Markers of Involvement by Non-small Cell Lung Cancer

Gallardo, J.F. Medina; Naranjo, Felipe Borderas; Cansino, M. Torres; Rodríguez-Panadero, Francisco

doi:10.1164/ajrccm/146.5_pt_1.1210

Cited by 18 publications

(3 citation statements)

References 5 publications

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“…'2 Preoperative assessment of mediastinal lymph nodes both clinically and radiologically is important, but the value of computed tomographic (CT) staging of bronchogenic carcinoma remains controversial. 3 Although most early studies reported that CT scanning had a high sensitivity for detecting mediastinal lymph node metastases,46 more recent studies suggest that CT scanning has a low sensitivity.7 In a study by McKenna et al,7 in which total nodal sampling was performed, a lower sensitivity (60%) was reported for the detection of mediastinal lymph node metastases with CT scanning than in earlier studies.…”

mentioning

confidence: 96%

Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes.

Arita

Kuramitsu

Kawamura

et al. 1995

Thorax

100

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Background -The incidence ofmetastases to mediastinal lymph nodes was evaluated in patients with normal sized mediastinal nodes on the computed tomographic (CT) scan who underwent thoracotomy. The use of hilar lymph nodes in predicting mediastinal lymph node metastases was also assessed. Methods -Ninety patients with non-small cell lung cancer who later underwent thoracotomy were prospectively examined by CT scanning. Lymph nodes with a short axis diameter of 10 mm or more were considered abnormal. Results -Mediastinal lymph node metastases were present at thoracotomy in 19 patients (21%). In 14 these lymph node metastases were misdiagnosed because the nodes were normal in size on the CT scan. In only one ofthe 19 patients with N2 nodes was an Ni lymph node enlarged, and four ofthe 19 patients with N2 nodes had metastases to these mediastinal nodes without Ni disease ("skipping metastases"). Conclusions -Metastases in normal sized nodes seen on the CT scan are a major problem in staging. Hilar lymph nodes did not help to predict reliably the presence or absence ofmetastases to the mediastinal lymph nodes.

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mentioning

confidence: 96%

Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes.

Arita

Kuramitsu

Kawamura

et al. 1995

Thorax

100

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“…4 [18,20,21]. Do wyników powyższych prac należy się jednak odnieść krytycznie z uwagi na brak wiarygodnych testów weryfikujących skuteczność biopsji oraz nadmierny odsetek dodatnich wyników biopsji, znacznie przewyższający dane z piśmiennictwa [22,23]. Wydaje się, że tylko na podstawie wyników obustronnej pełnej limfadenektomii można zweryfikować każdą metodę biopsji [4].…”

Section: Rak Płucaunclassified

Transbronchial Needle Aspiration as a Diagnostic Method in Lung Cancer and Non-Malignant Mediastinal Adenopathy

Szlubowski

Kużdżał²,

Soja³

et al. 2007

Advances in Respiratory Medicine

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Introduction: The aim of the study was to assess the diagnostic yield of transbronchial needle aspiration (TBNA) in mediastinal or hilar adenopathy in: lung cancer, staging of NSCLC, sarcoidosis and other non-malignant diseases. Material and methods: Transbronchial needle aspiration was performed in 347 consecutive patients—402 biopsies in groups of lymph nodes: subcarinal (7)—179, all paratracheal (2R, 2L, 4R, 4L)—168 and hilar (10R, 10L)—55, with no real-time imaging guidance, preceded by computed tomography (CT), using 22-gauge needles. All negative results in NSCLC patients were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) and the remaining patients underwent mediastinoscopy or thoracotomy. Results: TBNA technique was diagnostic in 67.1% of lung cancer patients and in 59.0% of patients with sarcoidosis. In the group of all lung cancer patients specificity was 100%, sensitivity 88.5%, accuracy 91.8% and negative predictive value 77.9% and in diagnosing of lymph nodes involvement in NSCLC was respectively 100%, 86.6%, 90.7% and 76.6%. The high diagnostic yield was comparable for all mediastinal groups. In 80% of NSCLC patients with false negative results of TBNA there was observed partial involvement of metastatic lymph nodes, confirmed by TEMLA. Conclusions: The diagnostic value of TBNA is very high in diagnostics of lung cancer, NSCLC staging and sarcoidosis but much lower in lymphomas, tuberculosis and other non-malignant diseases.

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“…Small lymph nodes may harbor malignancy, and lymph nodes Ͼ 1 cm in size are often benign. 3,6,[17][18][19]22,23,[31][32][33] In one study, 74% of positive mediastinal lymph nodes were misdiagnosed as negative because they were normal sized on CT. 3 As a result, the false-positive rate of CT ranges from 22 to 30%. 18,19,25 Subcarinal and right tracheobronchial nodes are commonly enlarged but are normal in patients with suspected lung cancer.…”

Section: Ctmentioning

confidence: 99%