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Outcomes of Incidental Mediastinal Lymphadenopathy Seen in Baseline Low Dose Screening CT Scans
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A7359 - Outcomes of Incidental Mediastinal Lymphadenopathy Seen in Baseline Low Dose Screening CT Scans
Author Block: R. S. Chatterjee1, C. R. Lamb2, M. M. Zambon2, S. M. Regis3; 1Internal Medicine, Mount Auburn Hospital, Cambridge, MA, United States, 2Department of Interventional Pulmonology, Lahey Clinic, Burlington, MA, United States, 3Radiation Oncology, Lahey Clnic, Burlington, MA, United States.
RATIONALE:
Incidental mediastinal lymphadenopathy (IML) has been sited in up to 1.5% of cases in patients who underwent coronary artery CT scans1. IML in Low Dose CT scans (LDCT) in high risk populations was reported by Morgan et al at a rate of 2.8%2. We conducted a retrospective, single institution study to analyze the incidence of IML found in baseline screening LDCT scans, defined by LUNG-RADS criteria of LR3 and LR4. Furthermore, we analyzed this population receiving LDCT scans over a one-year period to study the outcomes.
METHODS:
We created a database by categorizing all patients receiving an initial LDCT screen from Jan 1, 2012 to Sept 27, 2017. Positive scans were selected based on LUNG-RADS criteria of LR3 or LR4. We then isolated all scans that contained the word “lymph” in the radiology report and excluded all scans containing extra-thoracic lymph nodes (LN), all non-Lahey patients, and patients who had stable LN size compared to previous available radiographic exams, calcified LN, and sub-centimeter LN. We further excluded all patient with less than 1 year of follow up exams.
RESULTS:
We report an incidence of 1.2% (13/983 patients) of isolated IML in baseline positive LDCT scans. Of the eight patients followed by Lahey for one year, four had stable lymph nodes greater than 1 cm, two had a decrease in the size of LN, one was dis-enrolled due to terminal cardiopulmonary disease, and one showed an increase in the size of the LN, leading to PET scan and LN biopsy, which was negative for malignancy. Of those having LN and lung nodules, 17.6% (25/142 patients) proceeded to have a lymph node or lung biopsy, 60% (15/25) of whom were found to have a malignancy. Almost half the patients with malignancy were found to have primary adenocarcinoma of the lung. Interestingly, 53.3% of those with malignancy had subcarinal lymph node involvement.
CONCLUSION:
In conclusion, the incidence of isolated mediastinal lymphadenopathy in LDCT scans remains rare. In patients who had both LN and a non-calcified lung nodules, undergoing biopsy, a significant number were diagnosed with malignancy. There was a strong association between the enlargement of the subcarinal lymph node and the incidence of thoracic malignancy.
1.
Gil B et al. J Comput Assist Tomogr. 2007 Jan;31(1):1-4.
2.
Morgan L et al. 2017. Ann Am Thorac Soc. 2017 Sep;14(9):1456.
Author Block: R. S. Chatterjee1, C. R. Lamb2, M. M. Zambon2, S. M. Regis3; 1Internal Medicine, Mount Auburn Hospital, Cambridge, MA, United States, 2Department of Interventional Pulmonology, Lahey Clinic, Burlington, MA, United States, 3Radiation Oncology, Lahey Clnic, Burlington, MA, United States.
RATIONALE:
Incidental mediastinal lymphadenopathy (IML) has been sited in up to 1.5% of cases in patients who underwent coronary artery CT scans1. IML in Low Dose CT scans (LDCT) in high risk populations was reported by Morgan et al at a rate of 2.8%2. We conducted a retrospective, single institution study to analyze the incidence of IML found in baseline screening LDCT scans, defined by LUNG-RADS criteria of LR3 and LR4. Furthermore, we analyzed this population receiving LDCT scans over a one-year period to study the outcomes.
METHODS:
We created a database by categorizing all patients receiving an initial LDCT screen from Jan 1, 2012 to Sept 27, 2017. Positive scans were selected based on LUNG-RADS criteria of LR3 or LR4. We then isolated all scans that contained the word “lymph” in the radiology report and excluded all scans containing extra-thoracic lymph nodes (LN), all non-Lahey patients, and patients who had stable LN size compared to previous available radiographic exams, calcified LN, and sub-centimeter LN. We further excluded all patient with less than 1 year of follow up exams.
RESULTS:
We report an incidence of 1.2% (13/983 patients) of isolated IML in baseline positive LDCT scans. Of the eight patients followed by Lahey for one year, four had stable lymph nodes greater than 1 cm, two had a decrease in the size of LN, one was dis-enrolled due to terminal cardiopulmonary disease, and one showed an increase in the size of the LN, leading to PET scan and LN biopsy, which was negative for malignancy. Of those having LN and lung nodules, 17.6% (25/142 patients) proceeded to have a lymph node or lung biopsy, 60% (15/25) of whom were found to have a malignancy. Almost half the patients with malignancy were found to have primary adenocarcinoma of the lung. Interestingly, 53.3% of those with malignancy had subcarinal lymph node involvement.
CONCLUSION:
In conclusion, the incidence of isolated mediastinal lymphadenopathy in LDCT scans remains rare. In patients who had both LN and a non-calcified lung nodules, undergoing biopsy, a significant number were diagnosed with malignancy. There was a strong association between the enlargement of the subcarinal lymph node and the incidence of thoracic malignancy.
1.
Gil B et al. J Comput Assist Tomogr. 2007 Jan;31(1):1-4.
2.
Morgan L et al. 2017. Ann Am Thorac Soc. 2017 Sep;14(9):1456.
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