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. 2015 Jul;94(27):e1095.
doi: 10.1097/MD.0000000000001095.

Evaluation of Mediastinal Lymph Nodes in Sarcoidosis, Sarcoid Reaction, and Malignant Lymph Nodes Using CT and FDG-PET/CT

Hyun Jung Koo  1 , Mi Young Kim, So Youn Shin, Sooyoung Shin, Sung-Soo Kim, Sei Won Lee, Chang-Min Choi
Affiliations

Evaluation of Mediastinal Lymph Nodes in Sarcoidosis, Sarcoid Reaction, and Malignant Lymph Nodes Using CT and FDG-PET/CT

Hyun Jung Koo et al. Medicine (Baltimore). 2015 Jul.

Abstract

The aim of this study was to analyze the clinical, computed tomography (CT), and positron emission tomography (PET) findings of sarcoidosis, sarcoid reaction, and malignant lymph nodes (LNs) to the results of transbronchial LN aspiration and biopsy (TBNA).The TBNA results of mediastinal and hilar LNs of 152 patients in our hospital from July 2008 to March 2013 were retrospectively reviewed. Two independent radiologists measured the size and attenuation of LNs on CT and assessed the probability of the 3 categories: sarcoidosis (n = 36), sarcoid reaction (n = 25), or malignant LNs (n = 91). The total volume and attenuation of LNs were measured using Image J (NIH). The median maximum standardized uptake value (maxSUV) of the 3 mediastinal and hilar LNs on PET/CT was obtained.There was no significantly different CT finding between sarcoidosis and sarcoid reaction. Multivariate analysis showed that the age, total volume of LNs, and number of enlarged LNs significantly differed between sarcoid reaction and malignant LNs. Sarcoid reaction tends to be occurred in young patients (P = 0.007), the total volume of LNs was smaller (P = 0.04) than that of malignant LNs, and there were significantly more LNs >1 cm (P = 0.005). The median maxSUV of the 3 highest SUVs of the LNs did not significantly differ between the 3 entities.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Patient population in this study. CT = computed tomography, LNs = lymph nodes, PET = positron emission tomography, TBNA = transbronchial lymph node aspiration and biopsy.
FIGURE 2
FIGURE 2
A 57-year-old female patient with breast cancer diagnosed as sarcoid reaction of mediastinal LNs. The total volume and attenuation of mediastinal and hilar LNs on CT images were quantitatively measured using the Image J program by multiplying the diameters of all LNs in all axial images by the slice thickness. An example of slices on Image J is shown. The measured total volume of LNs was 16903.5 mm3. CT = computed tomography, LNs = lymph nodes.
FIGURE 3
FIGURE 3
A 44-year-old female with hepatocellular carcinoma (HCC) and papillary thyroid cancer. (A) Chest CT coronal image shows bilateral enlarged LNs (arrows) in the mediastinum and hilar areas. (B, C) FDG-PET/CT scan shows multiple hypermetabolic activity in the mediastinal and hilar LNs (arrows) and large masses (arrowheads) in the hepatic segment IV and upper abdomen. Initially, the patients suspected as HCC with multiple LNs metastasis in the thorax and upper abdomen. The maxSUV of thoracic LNs measured up to 6.8, 9.0, and 13.9. (D) The pathologic findings of the LNs obtained from transbronchial LN biopsy are revealed chronic noncaseating granulomatous inflammation (hematoxylin-eosin stain, original magnification × 100). CT = computed tomography, LNs = lymph nodes, FDG-PET/CT = 18F-fluorodeoxyglucose-positron emission tomography/CT, maxSUV = maximum standardized uptake value.
FIGURE 4
FIGURE 4
Box plots to show the distributions of the sizes of each nodal station, the number of LNs >1 cm, total volume, and attenuation of LNs in the sarcoid reaction and malignant LNs. (A–D) The LNs of sarcoid reaction tend to be larger with narrow spectrum than the malignant LNs (right lower paratracheal, 4R; subcarinal, 7; right hilar, 10R; left hilar, 10L). (E) There are more LNs >1 cm per patient in sarcoid reaction compared with the malignant LNs. (F) The total volume of LN is lower in sarcoid reaction than in malignant LNs. (G) The attenuation of all LNs is not significantly different between the 2 groups. LNs = lymph nodes.
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References

    1. Criado E, Sanchez M, Ramirez J, et al. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 2010; 30:1567–1586. - PubMed
    1. Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev 1986; 13:147–156. - PubMed
    1. Steinfort DP, Irving LB. Sarcoidal reactions in regional lymph nodes of patients with non-small cell lung cancer: incidence and implications for minimally invasive staging with endobronchial ultrasound. Lung Cancer 2009; 66:305–308. - PubMed
    1. Hunt BM, Vallieres E, Buduhan G, et al. Sarcoidosis as a benign cause of lymphadenopathy in cancer patients. Am J Surg 2009; 197:629–632.discussion 632. - PubMed
    1. Mapelli P, Mangili G, Picchio M, et al. Sarcoidosis mimicking metastatic gynaecological malignancies: a diagnostic and therapeutic challenge? Rev Esp Med Nucl Imagen Mol 2013; 32:314–317. - PubMed

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