Nilgün Yilmaz DEMİRCİ, İbrahim Onur ALICI, Aydin YILMAZ, Funda DEMİRAĞ, Ebru TATCI, Yurdanur ERDOĞAN

Risk factors and maximum standardized uptake values within lymph nodes of anthracosis diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

Background/aim: Enlarged mediastinal lymph nodes can result from serious etiologies including granulomatous disease, neoplasia, etc., and a rare condition called anthracosis . The aim of this study was to determine the incidence of risk factors and the uptake values within the anthracotic lymph nodes. Materials and methods: 106 patients who underwent endobronchial ultrasound transbronchial needle aspiration and were diagnosed as having anthracosis were analyzed retrospectively. Patients with positive confirmation by surgical biopsies or a 1-year follow-up period were enrolled. Results: 201 lymph nodes were sampled from 106 patients. Subcarinal and interlobar lymph nodes were the most commonly affected stations (36.8% and 34.3%, respectively). The mean durations of exposure to biomass and cigarette smoke were 35.5 and 33 years, respectively. The mean maximum standardized uptake value (SUVmax) within the lymph nodes was 4.76. The SUVmax of the patients with associated malignancy was 4.19 and the SUVmax of nonmalignant patients was 5.28. This difference was statistically significant (P = 0.009). Conclusion: These findings suggest that anthracosis also affects the mediastinal and hilar stations; it should be considered in differential diagnosis in patients with mediastinal and hilar lymphadenopathies with intense uptake on positron emission tomography scans, especially when there is a history of exposure to known risk factors.

Anahtar Kelimeler:

Endobronchial ultrasound, pulmonary anthracosis, positron emission tomography

Risk factors and maximum standardized uptake values within lymph nodes of anthracosis diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

Keywords:

Endobronchial ultrasound, pulmonary anthracosis, positron emission tomography,

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1. Sapkota A, Gajalakshmi V, Jetly DH, Roychowdhury S, Dikshit RP, Brennan P, Hashibe M, Boffetta P. Indoor air pollution from solid fuels and risk of hypopharyngeal/laryngeal and lung cancers: a multicentric case–control study from India. International Journal of Epidemiology 2008; 37: 321–328.
2. Onitilo AA, Engel JM, Tanimu SB, Nguyen TC. Anthracosis and large mediastinal mass in a patient with healed pulmonary tuberculosis. Clin Med Res 2010; 8: 99–103.
3. Chang JM, Lee JL, Goo MG, Lee HY, Lee JJ, Chung JK, Im JG. False positive and false negative FDG-PET scans in various thoracic diseases. Korean J Radiol 2006; 7: 57–69.
4. Nakajima T, Yasufuku K, Takahashi R, Shingyoji M, Hirata T, Itama M, Matsui Y, Itakura M, Iizasa T, Kimura H. Comparison of 21-gauge and 22-gauge aspiration needle during endobronchial ultrasound-guided transbronchial needle aspiration. Respirology 2011; 16: 90–94.
5. Tuthill RW. Woodstoves, formaldehyde, and respiratory disease. Am J Epidemiol 1984; 120: 952–955.
6. Hosgood HD, Boffetta P, Greenland S, Amy Lee YC, McLaughlin J, Seow A, Duell EJ, Andrew AS, Zaridze D, Szeszenia-Dabrowska N et al. In-home coal and wood use and lung cancer risk: a pooled analysis of the International Lung Cancer Consortium. Environ Health Perspect 2010; 118: 1743–1747
7. Akhtar T, Ulah Z, Khan MH, Nazli R. Chronic bronchitis in women using solid bio mass fuel in rural Peshawar, Pakistan. Chest 2007; 132: 1472–1475.
8. Bruce N, Perez-Padilla R, Albalak R. Indoor air pollution in developing countries: a major environmental and public health challenge. Bulletin of the World Health Organization 2000; 78: 1078–1092.
9. Ekici A, Ekici M, Kurtipek E, Akin A, Arslan M, Kara T, Apaydin Z, Demir S. Obstructive airway diseases in women exposed to biomass smoke. Environ Res 2005; 99: 93–98.
10. Bekci TT, Maden E, Emre L. Bronchial anthracofibrosis case with endobronchial tuberculosis. International Journal of Medical Sciences 2011; 8: 84–87.
11. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Lizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest 2004; 126: 122–128.
12. Ozgul MA, Cetinkaya E, Kirkil G, Ozgul G, Abul Y, Acat M, Onaran H, Urer HN, Tutar N, Dincer HE. Lymph node characteristics of sarcoidosis with endobronchial ultrasound. Endosc Ultrasound 2014; 3: 232–237.
13. Gounant V, Ninane V, Janson X, Colombat M, Wislez M, Grunenwald D, Bernaudin JF, Cadranel J, Fleury-Feith J. Release of metal particles from needles used for transbronchial needle aspiration. Chest 2011; 139: 138–143.
14. Hewitt RJ, Wright C, Adeboyeku D, Ornadel D, Berry M, Wickremasinghe M, Wright A, Sykes A, Kon OM. Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy. Respiratory Medicine Case Reports 2013; 10: 48–52.
15. Takemasa A, Bando M, Murayama F, Sohara Y, Hironaka M, Sugiyama Y. Clinical analysis of intra-pulmonary lymph nodes. Nihon Kokyuki Gakkai Zasshi 2001; 39: 322–327.
16. Kirchner J, Mueller P, Broll M et al. Chest CT Findings in EBUS-TBNA-proven anthracosis in enlarged mediastinal lymph nodes. Rofo 2014; 186: 1122–1126.
17. Fujiwara T, Yasufuku K, Nakajima T, Chiyo M, Yoshida S, Suzuki M, Shibuya K, Hiroshima K, Nakatani Y, Yoshino I. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest 2010; 138: 641–647.
18. Imai N, Imaizumi K, Ando M, Shimokata T, Ogawa T, Ito S, Hashimoto N, Sato M, Kondo M, Hasegawa Y. Echoic features of lymph nodes with sarcoidosis determined by endobronchial ultrasound. Intern Med 2013; 52: 1473–1478.
19. Park YS, Lee J, Pang JC, Chung DH, Lee SM, Yim JJ, Yang SC, Yoo CG, Kim YW, Han SK. Clinical implication of microscopic anthracotic pigment in mediastinal staging of non-small cell lung cancer by endobronchial ultrasound-guided transbronchial needle aspiration. J Korean Med Sci 2013; 28: 550–554.
20. Vansteenkiste JF, Stroobants SG. Positron emission tomography in the management of non-small cell lung cancer. Hematol Oncol Clin North Am 2004; 18: 269–288.
21. Lim JWM, Tang CL, Keng GHW. False positive F-18 fluorodeoxyglucose combined PET/CT scans from suture granuloma and chronic inflammation: report of two cases and review of literature. Ann Acad Med Singapore 2005; 34: 457– 460.
22. Özgül MA, Çetinkaya E, Tutar N, Özgül G, Onaran H, Bilaceroglu S. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: a study in a tuberculosis-endemic country. Journal of Cancer Research and Therapeutics 2013; 9: 416–421.
23. Onitilo AA, Engel JM, Tanimu SB, Nguyen TC. Anthracosis and large mediastinal mass in a patient with healed pulmonary tuberculosis. Clin Med Res 2010; 8: 99–103.
24. Cheng NM, Yeh TW, Ho KC, Ng SH, Hsueh C, Yen TC, Liao CT. False positive F-18 FDG PET/CT in neck and mediastinum lymph nodes due to anthracosis in a buccal cancer patient. Clin Nucl Med 2011; 36: 963–964.
25. Canbaz F, Kefeli M, Sahin Z, Basoglu T. Anthracotic solitary pulmonary nodüle imitating lung malignancy on F-18 FDG PET/CT imaging. Clin Nucl Med 2011; 36: 955–956.
26. Reichert M, Bensadoun ES. PET imaging in patients with coal workers pneumoconiosis and suspected malignancy. Journal of Thoracic Oncology 2009; 4: 649–651.