Original article: general thoracicThe value of a noninvasive diagnostic approach to mediastinal masses
Section snippets
Material and methods
All records from our clinic between January 1986 and July 1999 were reviewed to identify patients with mediastinal tumors. Patients were only eligible if histology had been established and sufficient data about medical history, physical examination, and diagnostic findings were obtainable. Patients with esophageal malignancies and hernias into the mediastinum were excluded. Information about the patients was obtained through surgery clinic charts, in-patient records, pathology records,
Results
Between January 1986 and July 1999, 354 patients with mediastinal masses underwent operations in our clinic. After exclusion of esophageal malignancies, cardiac tumors, and hernias, there were 323 patients remaining in our database. Twenty-four patients had to be excluded because of insufficient histologic or diagnostic data. Thus, there were 299 patients included in the study.
Symptoms and signs
Symptoms and signs in our series are shown in Table 2. There were 243 (81.3%) symptomatic patients in our series. The symptomatic population of either group, MLA and NLMT, was 81.2% and 81.4%, respectively. Common symptoms, evenly distributed between both groups, were thoracic symptoms such as shortness of breath, cough, and chest pain.
Systemic symptoms such as weight loss, night sweats, or fever (p = 0.005) and laboratory signs of inflammation such as C-reactive protein, leukocytosis, and
Diagnostic accuracy of noninvasive diagnostic approach
The noninvasive diagnostic approach included medical history, physical findings, laboratory results, chest radiograph, and CT scan. All patients were initially evaluated with posteroanterior and lateral chest radiograph. CT scan was used in 281 (94.0%) patients.
Tumors of uncertain histology
In 35 (11.7%) patients, the entity of the mediastinal mass could not be defined, as to allocate them to the MLA or NLMT groups. Twenty-six of these tumors were histologically diagnosed as MLA: four malignant lymphomas, three sarcoidosis, two lymph node tuberculosis, one nonspecific infectious lymphadenopathy, and 16 metastases. In nine of the unclear mediastinal masses, the histologic evaluation revealed NLMT: three thymic tumors, three mesenchymal tumors, two neurogenic tumors, and one germ
Mediastinal lymphadenopathy
In the MLA group, 216 (90.0%) patients were correctly identified. Four (1.7%) MLAs (one Hodgkin’s, three nonspecific lymphadenopathy) were mistakenly diagnosed as NLMT.
Nonlymphatic mediastinal tumors
Among the patients with NLMT, 37 (67.3%) were correctly diagnosed by noninvasive investigations. In six cases (10.5%), NLMT was confused with LMT (two thymomas, one thymic tumor, one carcinoid, one teratoma, one cystic lymphangioma). The statistical analysis for the noninvasive diagnostic approach is shown in Table 3.
Comment
Given the wide variability of histology presenting as mediastinal mass, a standardized diagnostic and therapeutic workup is instrumental. In our study, we investigated the accuracy of noninvasive diagnostic studies, including medical history, laboratory tests, chest radiograph, and CT scan, representing the common first-line diagnostic approach to mediastinal masses [3]. We addressed the question of whether this basic diagnostic approach is sufficient in separating lymphatic tumors that require
Acknowledgments
We thank Dr Douglas R. Johnston for critically reading the manuscript.
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