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Mediastinal lymph node size in lung cancer.

H I Libshitz, R J McKenna

    AJR. American Journal of Roentgenology
    |October 1, 1984
    PubMed
    Summary

    Mediastinal lymph node size on computed tomography (CT) scans is a poor indicator of metastasis in lung cancer patients. A size of 1 cm or greater does not reliably predict cancer spread, even with pneumonia or granulomatous disease.

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    Area of Science:

    • Oncology
    • Radiology
    • Thoracic Surgery

    Background:

    • Mediastinal lymph node status is crucial for lung cancer staging.
    • Computed tomography (CT) is a primary imaging modality for evaluating lymph nodes.
    • Nodal size is a commonly used criterion for abnormality, but its predictive value for malignancy requires scrutiny.

    Purpose of the Study:

    • To evaluate the accuracy of mediastinal lymph node size (≥1 cm) on CT as a predictor of metastatic involvement in patients with bronchogenic carcinoma.
    • To determine the sensitivity and specificity of nodal size in predicting metastases.
    • To assess the impact of complicating factors like obstructive pneumonia and granulomatous disease on the predictive value of nodal size.

    Main Methods:

    • Retrospective analysis of 86 patients who underwent surgery for bronchogenic carcinoma with full nodal sampling.
    • Correlation of CT-identified mediastinal lymph node size (≥1 cm) with surgically confirmed metastatic status.
    • Subgroup analysis including patients with obstructive pneumonia and those with a history of granulomatous disease.

    Main Results:

    • A CT size of ≥1 cm had a sensitivity of 67% and specificity of 66% for predicting mediastinal metastases.
    • In patients with obstructive pneumonia, 45% had nodes ≥1 cm, but only 10 of these harbored metastases.
    • Even in patients with prior granulomatous disease or no apparent benign cause, only 25% of nodes ≥1 cm were metastatic.

    Conclusions:

    • Mediastinal lymph node size on CT is an unreliable predictor of metastatic disease in lung cancer.
    • The presence of obstructive pneumonia or granulomatous disease does not increase the likelihood that enlarged nodes are malignant.
    • Nodal size alone should not be the sole criterion for determining mediastinal metastatic involvement.

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