Computerized Tomography Characterization of Mediastinal Lymph Node Masses with Fine Needle Aspiration Cytology Correlation

Introduction: Lung cancer is the most common cancer among men in developed nations, and generally has a poor prognosis. Metastasis of lung cancer to mediastinal lymph nodes presents with a diagnostic dilemma, and many a time, it may be the only presenting sign for lung cancer. Materials and Methods: All the participants underwent a computerized tomography (CT) imaging of the thorax using a GE Hispeed FX/I spiral CT scanner. Unenhanced CT imaging was done on all patients, with contiguous 10 mm sections obtained at an interval if 1 cm and scanning time of 3-4 s. The distribution, attenuation, and enhancement characteristics of the lymph nodes were evaluated after an intravenous bolus of ionic/non-ionic contrast. All the patients also underwent fine needle aspiration cytology of the lymph node to ascertain the pathophysiology of mediastinal lymphadenopathy. Results: A total of 32 participants were finally included in the study. Among the participants aged < 39 years, most (42.8%) were having lymphoma. At the same time, in those participants aged > 40, all of them were having metastatic lesions of the lungs. Among those who reported dyspnea, 75% of the participants were suffering from a malignant lesion of lung, while 25% had lymphoma. Among those participants who had extra-thoracic lymphadenopathy, 86.6% had metastatic lesion of the lung, with the rest having lymphoma and granulomatous lesion of the lungs. Among the patients with no extra-thoracic lymphadenopathy, the vast majority (76.4%) were suffering from metastatic lesions from the lungs. Conclusion: It was found that the vast majority of patients presenting with mediastinal lymph node enlargement has an underlying lung malignancy presenting as metastasis. Furthermore, CT scan is a modality with can aid in diagnosis and staging of the lymph node enlargement but it cannot replace the importance of a tissue diagnosis.