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Foreign Body Reaction Mimicking Lymph Node Metastasis is Not Rare After Lung Cancer Resection.
Berk Cimenoglu1, Talha Dogruyol1, Attila Ozdemir1
1Thoracic Surgery Department, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
The Thoracic and Cardiovascular Surgeon
|August 28, 2023
Summary
Foreign body reactions can mimic lung cancer recurrence in mediastinal lymph nodes after surgery. These reactions present earlier and show lower 18-fluorodeoxyglucose uptake than actual metastases.
Area of Science:
- Oncology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Mediastinal lymphadenopathy with high 18-fluorodeoxyglucose uptake post-lung cancer surgery often suggests recurrence, necessitating invasive diagnostics.
- Peroperative oxidized cellulose for bleeding control can cause foreign body reactions, mimicking metastasis in lymph nodes.
Purpose of the Study:
- To investigate the clinicopathological features of foreign body reactions mimicking mediastinal lymph node metastasis after lung cancer surgery.
- To determine the frequency of such iatrogenic causes of lymphadenopathy.
Main Methods:
- Retrospective analysis of 34 patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for suspected mediastinal recurrence post-lung cancer surgery (Jan 2016 - Aug 2021).
- Patients were categorized into metastasis, foreign body reaction, and reactive lymph node groups based on EBUS-TBNA results.
- Clinicopathological features and imaging characteristics (SUVMax) were compared between groups.
Main Results:
- Of 34 patients, 52.9% had metastasis, 29.4% had foreign body reaction, and 17.6% had reactive lymph nodes.
- The foreign body group showed a significantly lower mean SUVMax (5.48 ± 2.54) compared to the metastasis group (9.39 ± 4.69) (p=0.022).
- The time interval from surgery to EBUS-TBNA was shorter for the foreign body group (14.90 ± 12.51 months) than the metastasis group (23.72 ± 10.48 months) (p=0.015).
Conclusions:
- Foreign body reaction is a notable cause of mediastinal lymphadenopathy mimicking metastasis in post-lung cancer surgery patients.
- Iatrogenic foreign body reactions tend to present earlier post-surgery and exhibit lower FDG uptake than metastatic disease.
