In the present study, the size of the lymph nodes was measured on TEE and nodal specimens in long- and short-axis diameter. There were no differences between malignant and benign nodes in both diameters. Furthermore, normal-sized N2 nodes were demonstrated in 73% of N2 nodes on TEE, and mediastinal lymph node metastases on CT were misdiagnosed in 64% of patients with N2 nodes because of normal-sized N2 nodes. These findings indicate that we are not able to reliably differentiate malignant mediastinal lymph nodes from benign nodes by size because of high frequency of normal-sized N2 nodes. Kerr et al reported that there were no significant differences between malignant nodes and benign nodes in diameter, and concluded that malignant mediastinal nodes were not larger than benign nodes and small lymph nodes were not infrequently malignant. This report supports our data in relationship of size between malignant and benign nodes. Read the rest of this entry »
Archive for the ‘Lymph node’ Category
Of the 40 bronchogenic carcinomas, 27 were adenocarcinomas, 12 were squamous cell carcinomas, and 1 was large cell carcinoma. Mediastinal lymph node metastases were present in 11 (28%) of the 40 patients: 8 patients with adenocarcinoma and 3 with squamous cell carcinoma. A total of 198 mediastinal nodal station samples were obtained (average, 5.0 per patient) (Table 1). A total of 208 mediastinal lymph nodes were dissected at thoracotomy. Fifty-one mediastinal lymph nodes were detected by CT. Normal-sized N2 nodes on CT were demonstrated in 4 of 11 patients with N2 nodes (Table 2, cases 8 through 11); in 3 of 11 patients, metastatic tumors were present not in the enlarged nodes but rather in nodes that were undetectable on CT image in different nodal stations (Table 2, cases 1 through 3). As a result, in 7 (64%) of 11 patients with N2 nodes, mediastinal lymph node metastases were misdiagnosed by chest CT because of normal-sized N2 nodes (Tables 2 and 3). Read the rest of this entry »
Is It Possible To Differentiate Malignant Mediastinal Nodes From Benign Nodes by Size? (Materials and Methods)
Between May 1992 and October 1994, 114 patients visited our department for treatment of primary lung cancer. Among them, we prospectively evaluated mediastinal lymph nodes in 40 patients using CT and TEE; these patients later underwent thoracotomy. There were 30 men and 10 women aged 40 to 79 years (mean, 64 years). In preoperative staging, numbers of patients with stage I, stage II, and stage IIIA were 24 patients, 3 patients, and 13 patients, respectively. Eighteen of the remaining 74 patients underwent thoracotomy because of preoperative stage I to IIIA. However, these patients were not contained in this study, because TEE examinations were not performed. We could not obtain informed consent from these patients. The remaining 56 patients did not undergo thoracotomy because of stage IIIB or stage IV or advanced age. These patients were treated with irradiation and chemotherapy. Selection criteria for thoracotomy were as follows: no visible direct mediastinal invasion by the tumor on CT; no enlarged contralateral mediastinal nodes seen on CT; and no known distant metastases. Read the rest of this entry »
Is It Possible To Differentiate Malignant Mediastinal Nodes From Benign Nodes by Size? (Introduction)
Study objective: To reevaluate whether it is possible to reliably differentiate malignant mediastinal lymph nodes from benign nodes by size, and to determine the frequency of metastases to normalsized mediastinal lymph nodes that directly affects the sensitivity for detecting malignant mediastinal lymph nodes (N2 nodes) on CT.
Design: Prospective study of patients with non-small cell lung cancer.
Setting: Department of Radiology and First Department of Surgery, Yamaguchi University School of Medicine.
Patients: We examined 40 patients with non-small cell lung cancer, who underwent thoracotomy because of operable stage (stage I, II, IIIA) in preoperative staging, using CT and transesophageal echocardiography (TEE).
Interventions: None. Read the rest of this entry »