PURPOSE: Patients with non-small cell lung cancer (NSCLC) may demonstrate sarcoidal reactions in their regional lymph nodes, and sometimes it is difficult to differentiate sarcoidal reactions from metastatic lymph nodes only by chest computed tomography (CT) or fluorodeoxyglucose positron emission tomography (FDG-PET). In this study, we investigate the clinical appearance of patients with NSCLC who revealed sarcoidal reactions in regional lymph nodes by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and evaluate the usefulness of EBUS-TBNA for accurate staging of NSCLC.
METHODS: We reviewed all patients who underwent EBUS-TBNA for initial diagnosis and mediastinal staging of NSCLC in our hospital from 2004 to 2010. We investigated the clinical course of patients who revealed sarcoidal reactions in regional lymph nodes.
RESULTS: 183 patients underwent EBUS-TBNA and 7(3.8%) showed sarcoidal reactions. Total number of lymph nodes with sarcoidal reaction was 12, and the median minor axis was 13.5 mm (range; 10-18 mm). Histological types were adenocarcinoma (3 patients), squamous cell carcinoma (3 patients), and large cell carcinoma (1 patient). Four patients underwent FDG-PET, and all demonstrated focal high-intensity FDG-avidity at each lymph node with a sarcoidal reaction. The clinical stage of these seven patients according to EBUS-TBNA varied from StageIB to IV. Two of them were down-staged by EBUS-TBNA; one underwent curative lobectomy and the other stereotactic radiosurgery.
CONCLUSIONS: 3.8% of NSCLC patients who underwent EBUS-TBNA revealed sarcoidal reactions in their regional lymph nodes, and were difficult to distinguish from metastatic lymph nodes by CT or FDG-PET. Pathological investigation by EBUS-TBNA led to accurate mediastinal staging, and 2 of 7 were down-staged and were given curative therapy.
CLINICAL IMPLICATIONS: NSCLC patients with sarcoidal reaction may be mistakenly overstaged only by imaging diagnosis such as CT or FDG-PET and thus may not be able to undergo curative therapy. Pathological confirmation is necessary for accurate mediastinal staging, and EBUS-TBNA is a non-invasive and reasonable procedure for this.
DISCLOSURE: The following authors have nothing to disclose: Rie Tsuboi, Kazumi Hori, Yoriko Funahashi, Saori Oka, Takashi Adachi, Misaki Ryuge, Yoshihito Kogure, Chiyoe Kitagawa, Masahide Oki, Hideo Saka
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