| Objective: By retrospective analysis of clinical data,imaging data and pathological data of patients with interstitial lung disease,the total incidence of mediastinal lymphadenopathy in patients with interstitial lung disease was counted,the incidence of mediastinal lymphadenopathy and imaging differences between subgroups of interstitial lung diseases were compared,the dynamic changes of lymph nodes before and after treatment were compared,the pathological results of mediastinal lymph nodes were summarized and analyzed,and the significance of mediastinal lymphadenopathy in patients with interstitial lung disease was discussed,which provided the basis and thinking for the diagnosis and treatment of mediastinal lymphadenopathy in patients with interstitial lung disease.Methods:From June 19,2019 to July 8,2020,patients with interstitial lung disease were hospitalized in the second Hospital of Hebei Medical University.The clinical data and imaging data were collected.The total incidence of mediastinal lymphadenopathy and the incidence and imaging characteristics of mediastinal lymphadenopathy in different etiological subgroups were analyzed.From January 2015 to July 2019,39 cases of mediastinal lymph node pathology were collected from the second Department of respiratory and critical care medicine of the second hospital of Hebei Medical University,who were diagnosed as interstitial lung disease and underwent endobronchial ultrasound-guided transbronchial needle aspiration.The pathological results of mediastinal lymph nodes were analyzed,and the imaging characteristics of benign lesions and malignant tumors were compared.Results:1.General data analysis: In 1011 patients with interstitial lung disease,486 cases were men(48.07%)and 525 cases were women(51.93%).The median age was 66(57,74)years.There were 363 cases of idiopathic interstitial pneumonia(35.91%)and 648 cases of interstitial lung disease(64.09%).2.Incidence of mediastinal lymphadenopathy associated with interstitial lung disease compared with subgroup : The incidence of mediastinal lymphadenopathy in patients with interstitial lung disease was27.9%(282/1011).The incidence of mediastinal lymphadenopathy in patients with idiopathic interstitial pneumonia and known etiology of interstitial lung disease was 27.0%(98/363)and 28.4%(184/648).Between idiopathic interstitial pneumonia group and known etiology of interstitial lung disease group,there was no significant difference in the incidence of mediastinal lymphadenopathy(P>0.05).The incidence of mediastinal lymphadenopathy in interstitial lung disease with other intrapulmonary lesions was 72.2%(26/36),significantly higher(26.3%,256/975)(P<0.05).3.Subgroup comparison of the incidence of mediastinal lymphadenopathy in patients with known of interstitial lung disease: Of the648 known cases of interstitial lung disease,the incidence of mediastinal lymphadenopathy was as follows: other pulmonary diseases associated with interstitial lung diseases(43.0%,34/79),unidentified interstitial lung disease(37.5%,3/8),connective tissue disease associated interstitial lung disease(26.4%,147/556),drug / chemical related interstitial lung disease(0.0%,0/5).The incidence of mediastinal lymphadenopathy in other lung diseases associated with interstitial lung diseases was significantly higher than that in connective tissue diseases associated with interstitial lung diseases(P<0.008).Of the 556 patients with connective tissue disease associated with interstitial lung disease,the incidence of mediastinal lymphadenopathy was as follows:Interstitial pneumonia with autoimmune features(45.6%,26/57),mixed connective tissue disease(41.7%,5/12),nodular vasculitis(38.3%,18/47),unclassified connective tissue disease(35.8%,19/53),rheumatoid arthritis(29.2%,26/89),dermatomyositis/polymyositis(23.2%,22/95),Sjogren’s syndrome(20.3%,15/74),systemic lupus erythematosus(20.0%,7/35),overlap syndrome(13.3%,8/60),other connective tissue diseases(5.9%,1/17),systemic sclerosis(0.0%,0/17).The incidence of mediastinal lymphadenopathy in IPAF patients was significantly higher than that in systemic sclerosis,overlap syndrome associated interstitial lung disease(P<0.001).4.Analysis of imaging features of pathological lymph nodes: 98 cases were idiopathic interstitial pneumonia with mediastinal lymphadenopathy,most of which were multiple.The median short axis diameter was12.5(12,14)mm.The maximum value of SAD was 33 mm and the minimum value of SAD was 10 mm.The SAD of 94 cases(95.8%)were in the range of10-20mm(including 10mm),2 cases(2.1%)were in the range of 20-30mm(including 20mm),2 cases(2.1%)were in the range of ≥ 30 mm,and 18 cases(18.4%)were complicated with other pulmonary lesions.184 cases were interstitial lung disease with mediastinal lymphadenopathy of known etiology,mainly multiple.The average SAD was 12.5(11,13)The maximum value of SAD was 34 mm,and the minimum value of SAD was 10 mm.The SAD of176 cases(95.7%)were in the range of 10-20mm(including 10mm),5 cases(2.7%)were in the range of 20-30mm(including 20mm),3 cases(1.6%)were in the range of ≥ 30 mm,and 8 cases(4.3%)were complicated with other pulmonary lesions.Patients with idiopathic interstitial pneumonia with mediastinal lymphadenopathy were more likely to have intrapulmonary lesions than those with known etiology(P<0.05);idiopathic interstitial pneumonia and interstitial lung disease with known etiology had no significant difference in the number,size,and location of the SAD of the mediastinal lymph nodes(PP<0.05).5.Analysis of lymph node pathology: A total of 39 cases of interstitial lung disease were collected through EBUS-TBNA to obtain mediastinal lymph node pathology,among them,31 cases had benign lesions(79.5%),8cases had malignant tumors(20.5%),5 cases had adenocarcinoma,1 cases had squamous cell carcinoma,2 cases can not be classified.In the malignant tumor group,7 patients had lymph node SAD > 15 mm,accounting for 87.5%.4patients had pulmonary space occupying lesions,1 patient had malignant solitary pulmonary nodule,and 1 patient had massive unilateral pleural effusion.The diameter of mediastinal lymph nodes in malignant tumor group was significantly larger than that in benign lesion group(P < 0.05),and the possibility of lung lesions in malignant tumor group was significantly higher than that in benign lesion group(P < 0.05).6.Changes of mediastinal lymph nodes before and after treatment: A total of 133 patients received anti-infection,hormone,anti-infection and hormone treatment after secondary chest high-resolution computed tomography.Among 38 patients with idiopathic interstitial pneumonia,5 cases(13.2%)had enlarged lymph nodes,14 cases(36.8%)had smaller lymph nodes,and 16 cases(42.1%)had no significant change.There was no significant difference in the changes of lymph nodes among different treatment schemes(P > 0.05).Among 95 patients with known etiology of interstitial lung disease,26 cases(27.4%)had enlarged lymph nodes,23 cases(24.2%)had narrowed lymph nodes,and 43 cases(45.3%)had no obvious change.There was no significant difference in the changes of pathological lymph nodes between the two groups(P > 0.05).Conclusion:1.The incidence of mediastinal lymphadenopathy was 27.9% in patients with interstitial lung disease.2.There was no statistical difference in the incidence of mediastinal lymph node enlargement between idiopathic interstitial pneumonia group and interstitial lung disease group with known etiology,and there was no statistical difference in the number of mediastinal lymph nodes,the size of short axis diameter and the location between the two groups.3.The incidence of mediastinal lymphadenopathy in interstitial lung disease with other intrapulmonary lesions was significantly higher than that in interstitial lung disease without other intrapulmonary lesions.4.The incidence of mediastinal lymphadenopathy in patients with other lung diseases related to interstitial lung diseases was significantly higher than that in connective tissue diseases related to interstitial lung diseases.5.The incidence of mediastinal lymphadenopathy in patients with IPAF was significantly higher than that in patients with systemic sclerosis and overlap syndrome.6.Of 39 patients with interstitial lung disease with mediastinal lymphadenopathy with pathological results,31 cases had benign lesions(79.5%)and 8 cases had malignant tumors(20.5%),the diameter of mediastinal lymph nodes in malignant tumor group was significantly larger than that in benign lesion group(P<0.05),and the rate of intrapulmonary lesions in malignant tumor group was higher than that in benign lesion group(P<0.05).7.There was no significant difference in mediastinal lymph node changes in patients with idiopathic interstitial pneumonia and interstitial lung disease. |
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