Bronchogenic carcinoma: Incidence of metastases to normal sized lymph nodes

Abstract

Background- The incidence of metastases to mediastinal lymph nodes was evaluated in patients with normal sized mediastinal nodes on the computed tomographic (CT) scan who underwent thoracotomy. The use of hilar lymph nodes in predicting mediastinal lymph node metastases was also assessed. Methods - Ninety patients with non-small cell lung cancer who later underwent thoracotomy were prospectively examined by CT scanning. Lymph nodes with a short axis diameter of 10mm or more were considered abnormal. Results - Mediastinal lymph node metastases were present at thoracotomy in 19 patients (21%). In 14 these lymph node metastases were misdiagnosed because the nodes were normal in size on the CT scan. In only one ofthe 19 patients with N2 nodes was an Ni lymph node enlarged, and four of the 19 patients with N2 nodes had metastases to these mediastinal nodes without Ni disease ("skipping metastases"). Conclusions - Metastases in normal sized nodes seen on the CT scan are a major problem in staging. Hilar lymph nodes did not help to predict reliably the presence or absence ofmetastases to the mediastinal lymph nodes.