Management of Isolated Thoracic Lymphadenopathy of Unclear Etiology: A Survey of Physicians and Literature Review

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dc.contributor.authorPathak, Vikas
dc.contributor.authorAdhikari, Nawaraj
dc.contributor.authorConklin, Courtney
dc.contributor.otherUniversity of Alabama Tuscaloosa
dc.date.accessioned2023-09-28T19:06:34Z
dc.date.available2023-09-28T19:06:34Z
dc.date.issued2023
dc.description.abstractBackgroundAfter identifying incidental mediastinal lymph nodes, decisions need to be made regarding the required follow-up imaging, the intervals at which this imaging should be performed, the types of imaging and procedures needed, and when to discontinue the follow-up. The purpose of this study is to determine the majority opinion on the management of these findings and provide recommendations for future management of incidental mediastinal lymphadenopathy.MethodologySixty-two healthcare providers from a variety of specializations were surveyed on their preference for diagnostic workup and subsequent follow-up following the finding of incidental mediastinal lymphadenopathy on computed tomography (CT) of the chest.ResultsFor thoracic lymphadenopathy of unclear etiology and patients who are not offered endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), most providers (47/62, 75.8%) initiate the CT scan follow-up at size 10 to 14 mm. Of those patients, 51.6% (32/62) of providers repeat the initial CT scan in three months and 41.9% (26/62) repeat the initial CT scan in six months. If the follow-up CT chest shows stable lymphadenopathy, 47.5% (29/62) repeat a CT chest every six months and 37% (23/62) repeat a CT chest every 12 months. The majority of providers (42/62, 67.7%) do not use positron emission tomography (PET)-CT for the initial evaluation of isolated thoracic lymphadenopathy and follow-up of lymphadenopathy with increasing size. For thoracic lymph nodes with a maximum diameter of 10 mm, only 4.8% (3/62) of providers continue CT screening after 24 months, while 24.6% (15/62) of providers continue CT screening after 24 months for sizes greater than 20 mm. Regarding the timing of EBUS-TBNA, 40.3% (25/62) of providers consider referring/performing this procedure at lymph nodes of size 11-15 mm, followed by 21% (13/62) of providers referring/performing the procedure at size 10 mm.ConclusionsThe majority of providers initiate CT scan follow-ups at 10 to 14 mm size for patients with isolated thoracic lymphadenopathy. The majority of providers do not use PET-CT for the initial evaluation of isolated thoracic lymphadenopathy. We found variable responses from providers regarding the timing of follow-up intervals and total duration. There is a need for consensus guidelines regarding the management of thoracic lymphadenopathy of unclear etiology.en_US
dc.format.mediumelectronic
dc.format.mimetypeapplication/pdf
dc.identifier.citationPathak, V., Adhikari, N., & Conklin, C. (2023). Management of Isolated Thoracic Lymphadenopathy of Unclear Etiology: A Survey of Physicians and Literature Review. In Cureus. Springer Science and Business Media LLC. https://doi.org/10.7759/cureus.41867
dc.identifier.doi10.7759/cureus.41867
dc.identifier.urihttps://ir.ua.edu/handle/123456789/10875
dc.languageEnglish
dc.language.isoen_US
dc.publisherSpringer Nature
dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectfollow up
dc.subjectisolated lymph node
dc.subjecthilar lymph nodes
dc.subjectmediastinal lymph nodes
dc.subjectthoracic lymph nodes
dc.subjectSIGNIFICANT NONCARDIAC FINDINGS
dc.subjectMEDIASTINAL LYMPH-NODES
dc.subjectPREVALENCE
dc.subjectSCANS
dc.subjectENLARGEMENT
dc.subjectMedicine, General & Internal
dc.titleManagement of Isolated Thoracic Lymphadenopathy of Unclear Etiology: A Survey of Physicians and Literature Reviewen_US
dc.typeReview
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