Dataset Information

A retrospective observational study of benign anthracotic lymphadenitis and its association with PET avid lymph nodes in patients undergoing cancer evaluation.

ABSTRACT:

Background

Accurate staging of newly diagnosed or recurrent malignancy is essential for effective treatment. An important first step in staging involves the use of PET/CT to identify areas of FDG avidity. PET/CT however has limitations, including false positive FDG uptake from benign causes. In this paper we characterize an uncommon yet clinically important cause of false positive PET/CTs, that of benign anthracotic lymphadenitis (BAL). We examine the clinical, radiographic and histologic characteristics of BAL in patients referred for endobronchial ultrasound (EBUS) guided biopsies and discuss its context in relation to existing literature.

Methods

We performed a retrospective observational case series of 20 patients who were referred for EBUS guided biopsies of PET positive mediastinal and hilar lymph nodes during the work-up or treatment of suspected malignancy.

Results

To be included, all patients received PET imaging as well as an EBUS guided biopsy of FDG avid lymph nodes which demonstrated anthracotic pigment as the only histologic abnormality. The key findings were that 90% of patients in this cohort were born outside of the US, 90% had bilateral FDG avid lymph nodes with an average standardized uptake value (SUV) of 7.9±2.2. Most patients, based on their history, had a likely exposure to biomass fuel or urban pollution.

Conclusions

BAL may be an underrecognized cause for PET positive lymph nodes in patients undergoing work-up for malignancy. These findings support the importance of sampling mediastinal and hilar lymph nodes even when SUVs are highly suggestive of malignancy.

SUBMITTER: Ivanick NM

PROVIDER: S-EPMC8339750 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

A retrospective observational study of benign anthracotic lymphadenitis and its association with PET avid lymph nodes in patients undergoing cancer evaluation.

Ivanick Nathaniel M NM Shrestha Pavan P Podolsky Michael J MJ Walavalkar Vighnesh V Lucas Calixto-Hope CH Gesthalter Yaron B YB Seeley Eric J EJ

Journal of thoracic disease 20210701 7

<h4>Background</h4>Accurate staging of newly diagnosed or recurrent malignancy is essential for effective treatment. An important first step in staging involves the use of PET/CT to identify areas of FDG avidity. PET/CT however has limitations, including false positive FDG uptake from benign causes. In this paper we characterize an uncommon yet clinically important cause of false positive PET/CTs, that of benign anthracotic lymphadenitis (BAL). We examine the clinical, radiographic and histologi ...[more]

PMID: 34422351

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Project description:The composition of lymph nodes in pediatric patients is different from that in adults. Most notably, normal lymph nodes in children contain less macrophages. Therefore, previously described biodistributions of iron oxide nanoparticles in benign and malignant lymph nodes of adult patients may not apply to children. The purpose of our study was to evaluate if the iron supplement ferumoxytol improves the differentiation of benign and malignant lymph nodes in pediatric cancer patients on 18F-FDG PET/MRI. Methods: We conducted a prospective clinical trial from May 2015 to December 2018 to investigate the value of ferumoxytol nanoparticles for staging of children with cancer with 18F-FDG PET/MRI. Ferumoxytol is an FDA-approved iron supplement for the treatment of anemia and has been used "off-label" as an MRI contrast agent in this study. Forty-two children (7-18 years, 29 male, 13 female) received a 18F-FDG PET/MRI at 2 (n=20) or 24 hours (h) (n=22) after intravenous injection of ferumoxytol (dose 5 mg Fe/kg). The morphology of benign and malignant lymph nodes on ferumoxytol-enhanced T2-FSE sequences at 2 and 24 h were compared using a linear regression analysis. In addition, ADCmean-values, SUV-ratio (SUVmax lesion/SUVmean liver) and R2*-relaxation rate of benign and malignant lymph nodes were compared with a Mann-Whitney-U test. The accuracy of different criteria was assessed with a receiver operating characteristics (ROC) curve. Follow-up imaging for at least 6 months served as the standard of reference. Results: We examined a total of 613 lymph nodes, of which 464 (75.7%) were benign and 149 (24.3%) were malignant. On ferumoxytol-enhanced T2-FSE images, benign lymph nodes showed a hypointense hilum and hyperintense parenchyma, while malignant lymph nodes showed no discernible hilum. This pattern was not significantly different at 2 h and 24 h postcontrast (p=0.82). Benign and malignant lymph nodes showed significantly different ferumoxytol enhancement patterns, ADCmean values of 1578 and 852 x10-6 mm2/s, mean SUV-ratios of 0.5 and 2.8, and mean R2*-relaxation rate of 127.8 and 84.4 Hertz (Hz), respectively (all p<0.001). The accuracy of ADCmean, SUV-ratio and pattern (area under the curve (AUC): 0.99; 0.98; 0.97, respectively) was not significantly different (p=0.07). Compared to these three parameters, the accuracy of R2* was significantly lower (AUC: 0.93; p=0.001). Conclusion: Lymph nodes in children show different ferumoxytol-enhancement patterns on MRI than previously reported for adult patients. We found high accuracy (>90%) of ADCmean, SUV-ratio, pattern, and R2* measurements for the characterization of benign and malignant lymph nodes in children. Ferumoxytol nanoparticle accumulation at the hilum can be used to diagnose a benign lymph node. In the future, the delivery of clinically applicable nanoparticles to the hilum of benign lymph nodes could be harnessed to deliver theranostic drugs for immune cell priming.

Project description:BackgroundThe endobronchial ultrasound (EBUS) elastography is a diagnostic tool used for measuring the elasticity of intrathoracic lesions. It is still essential for discussions about how accurate elastography is at identifying benign and malignant mediastinal and hilar lymph nodes. The objective of this study was to investigate the diagnostic utility of EBUS elastography and to determine the variables affecting this procedure.MethodsWe conducted a single-center, retrospective study involving patients with suspected lung cancer who underwent EBUS elastography followed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) at Zhejiang Cancer Hospital between October 2021 and March 2023. The pathological results of EBUS-TBNA, validated through a six-month follow-up, served as the gold standard. Each lymph node had its ultrasonic elastography indices recorded, including the elastography grading score, blue color ratio (BCR), blue color score, and short axis diameter. The diagnostic efficacy of elastography was assessed using the receiver operating characteristic (ROC) curve, which differentiated between benign and malignant lymph nodes. To investigate the factors impacting the elastography indices, multivariate logistic regression was used with multiple serological markers, lymph node location, and pathology.ResultsOf the 168 patients, 322 lymph nodes were punctured, with 175 (54.3%) being malignant. The area under the ROC curve (AUC) for the combined index of elastography grading score and short-axis diameter was 0.702 [95% confidence interval (CI): 0.645-0.759]. While the pathology of the lymph nodes was found to influence the BCR, BCR was unable to distinguish between lymph nodes with benign conditions and those with small cell carcinoma.ConclusionsThe use of elastography data alone may be inadequate for diagnosing metastatic lymph nodes. However, elastography can provide supplementary diagnostic information during EBUS-TBNA. Invasive EBUS-TBNA remains recommended as it aids in the identification of malignant lymph nodes when used in conjunction with pathological, radiological, and clinical findings.

Dataset Information

A retrospective observational study of benign anthracotic lymphadenitis and its association with PET avid lymph nodes in patients undergoing cancer evaluation.

Background

Methods

Results

Conclusions

Publications

A retrospective observational study of benign anthracotic lymphadenitis and its association with PET avid lymph nodes in patients undergoing cancer evaluation.

Similar Datasets

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