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Published on: May 4, 2022
Intrapulmonary lymph nodes detected by exploratory video-assisted thoracoscopic surgery: appearance of helical
Y Tsunezuka1, H Sato, C Hiranuma
1Department of Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan.
Insights
Distinguishing intrapulmonary lymph nodes (IPLNs) from malignant lesions using helical computed tomography (CT) is challenging. Exploratory video-assisted thoracoscopic surgery (E-VATS) remains essential for accurate diagnosis and excluding cancer.
Area of Science:
- Thoracic imaging
- Pulmonary pathology
- Surgical diagnostics
Background:
- Intrapulmonary lymph nodes (IPLNs) can mimic malignant lung nodules on imaging.
- Accurate preoperative differentiation is crucial to avoid unnecessary surgical intervention.
Purpose of the Study:
- To analyze helical computed tomography (CT) findings of IPLNs.
- To evaluate diagnostic procedures for differentiating IPLNs from malignant lesions.
- To assess the necessity of exploratory surgery.
Main Methods:
- Retrospective analysis of helical CT images from 8 patients with pathologically proven IPLNs.
- Review of associated CT findings suggestive of malignancy.
- Correlation with thoracoscopic findings and pathological results.
Main Results:
- IPLN diameters ranged from 4-10mm, predominantly in lower lobes.
- Malignancy-suggesting CT findings observed in some IPLNs included pleural indentation, spicular radiation, fuzzy margins, and vascular involvement.
- Pathological confirmation revealed anthracotic pigment in 5 subpleural IPLNs.
- One case highlighted diagnostic ambiguity between IPLN and metastatic carcinoma.
Conclusions:
- Helical CT findings alone are insufficient to reliably distinguish IPLNs from malignant lung lesions.
- Exploratory video-assisted thoracoscopic surgery (E-VATS) is a necessary and definitive procedure for preoperative exclusion of malignancy.
Abstract:
The objective of this study was to analyze helical computed tomography (CT) findings of intrapulmonary lymph nodes (IPLNs), and to evaluate the diagnostic procedures to prevent unnecessary exploratory surgery. Between April 1997 and March 2000, we performed exploratory video-assisted thoracoscopic surgery (E-VATS) in 42 patients and in 8 patients (4 men, 4 women; 48 to 75 years of age, mean 57 years) IPLN was pathologically proven. Retrospectively, the appearances of IPLN in helical CT images were studied in detail. The diameter of the IPLNs varied from 4 to 10mm. Six nodules were located in the lower lobes and 2 nodule was in the lingula. Chest CT showed several malignancy-suggesting associated findings with pleural indentation (2/8), spicular radiation (2/8), fuzzy margins (4/8), and vascular involvement (2/8). Black colored anthracoses in 5 subpleural IPLNs were confirmed by thoracoscopy. One patient with two coin lesions was suggestive of lung metastasis of adenoidcystic carcinoma of the tongue, but one lesion was proven as IPLN, and the other as metastatic carcinoma. In conclusion, it is not possible to distinguish an intrapulmonary lymph node from a malignant lesion using the CT findings preoperatively. Therefore, a pathological study with E-VATS is necessary and sure procedure to exclude malignant disease under the present conditions.
