Extrapleural and cardiophrenic lymph nodes: prevalence, clinical significance and diagnostic value

Our plain-English summary of Extrapleural and cardiophrenic lymph nodes: prevalence, clinical significance and diagnostic value, by B. Feragalli, C. Mantini, N. Civitareale, et al (La Radiologia Medica, 2014).

The study

• Authors: B. Feragalli, C. Mantini, N. Civitareale, R. Polverosi, A. Tartaro, A.R. Cotroneo
• Journal: La Radiologia Medica
• Published: 2014;119(1):20-6
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The aim of this study was to evaluate the prevalence, clinical meaning and diagnostic value of extrapleural and cardiophrenic nodes occasionally observed on computed tomography (CT) scans of the chest.

Materials And Methods: We included 750 consecutive patients who underwent CT of the chest for different clinical purposes (340 nonneoplastic patients, 270 with extrathoracic neoplasms, 120 with intrathoracic neoplasms, 20 with pleural metastasis) and 91 patients with histologically proven malignant pleural mesothelioma (MPM). For each group of patients, we analysed the presence of extrapleural and cardiophrenic nodes, their number (single or multiple) and their size.

Results: The prevalence of cardiophrenic nodes between 6 and 10 mm and >10 mm was significantly higher in patients with MPM (28.6 and 26.4 %, respectively) than in all other categories of patients, except for patients with pleural metastasis (30 and 25 %, respectively). The prevalence of extrapleural nodes, independently from their size, was significantly higher in patients with MPM (68 %) compared with all other groups, including patients with pleural metastasis (5 %; p < 0.0001).

Conclusions: Cardiophrenic nodes >5 mm and extrapleural nodes of any size have a significant diagnostic value in malignant pleural disease, either primary or secondary, whereas they are extremely rare in other neoplastic or nonneoplastic diseases.

In plain English

The authors used chest CT scans to study cardiophrenic and extrapleural lymph nodes. Two chest radiologists reviewed scans of 750 consecutive patients scanned between January and September 2009. These were grouped as nonneoplastic, neoplasms outside the chest, neoplasms inside the chest, and pleural metastasis. They were compared with 91 patients with histologically proven malignant pleural mesothelioma (MPM). Extrapleural nodes were seen in 62 of 91 MPM patients (68%), significantly more often than in the other groups (0.7% to 5%). In MPM patients, cardiophrenic nodes of 6 to 10 mm were found in 28.6% and nodes over 10 mm in 26.4%. These rates were significantly higher than in the nonneoplastic and other neoplasm groups, but not significantly higher than in patients with pleural metastasis (30% and 25%). For cardiophrenic nodes of 5 mm or less, MPM patients did not differ significantly from any other group. The authors concluded that cardiophrenic nodes over 5 mm and extrapleural nodes of any size have diagnostic value in primary and secondary malignant pleural disease. The article did not assess asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Comparative CT imaging study that measured how often cardiophrenic and extrapleural lymph nodes were seen in different patient groups, comparing MPM patients with each other group by Chi square test
• Who was studied: 750 consecutive patients (430 men, 320 women; mean age 59 plus or minus 6 years) referred to the authors' institution for chest CT between January and September 2009. They were divided into 340 nonneoplastic patients, 270 with extrathoracic neoplasms, 120 with intrathoracic neoplasms and 20 with pleural metastasis. Also included were 91 patients (61 men, 30 women; mean age 67 plus or minus 9 years) with histologically proven malignant pleural mesothelioma, who had chest CT at the institute between January 2001 and September 2009.
• Exposure: Not applicable. The study did not assess asbestos or any fiber exposure. It compared lymph node findings on chest CT across disease groups.
• Main results:
  • Extrapleural nodes were found in 62 of 91 patients with MPM (68%).
  • Extrapleural nodes were found in:
• 3 of 340 nonneoplastic patients (0.9%)
• 2 of 270 patients with extrathoracic neoplasm (0.7%)
• 2 of 120 patients with intrathoracic neoplasm (1.6%)
• 1 of 20 patients with pleural metastasis (5%)
  • The prevalence of extrapleural nodes of any size was significantly higher in MPM patients than in all other groups, including patients with pleural metastasis.
  • Cardiophrenic nodes of any size were present in 60 of 91 MPM patients (66%), compared with 13 of 20 patients with pleural metastasis (65%).
  • Cardiophrenic nodes of 6 to 10 mm were found in 28.6% of MPM patients. This was significantly higher than in nonneoplastic patients (1.5%), patients with extrathoracic neoplasm (2.2%) and patients with intrathoracic neoplasm (2.5%).
  • Patients with pleural metastasis were the exception: 30% of them had cardiophrenic nodes of 6 to 10 mm. The comparison with MPM patients was not statistically significant.
  • Cardiophrenic nodes over 10 mm were found in 0.6% of nonneoplastic patients, 0.4% of patients with extrathoracic neoplasm and 0.8% of patients with intrathoracic neoplasm. They were found in 25% of patients with pleural metastasis and 26.4% of MPM patients.
  • For cardiophrenic nodes of 5 mm or less, there were no significant differences between MPM patients and each of the other four groups, including patients without neoplasm.
• The authors' conclusion: The authors concluded that cardiophrenic nodes larger than 5 mm and extrapleural nodes of any size have diagnostic value in both primary and secondary malignant pleural disease. In the discussion, they stated that extrapleural nodes should be considered pathological regardless of size, and cardiophrenic nodes only when larger than 5 mm.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Intrathoracic, Metastasis, Pleural Mesothelioma.

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