Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study
Articolo
Data di Pubblicazione:
2022
Citazione:
Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study / G. Levi, C. Rocchetti, F. Mei, G. Stella, S. Lettieri, F. Lococo, F. Taccari, C. Seguiti, M. Fantoni, F. Natali, P. Candoli, C. Bortolotto, V. Pinelli, M. Mondoni, P. Carlucci, A. Fabbri, M. Trezzi, L. Vannucchi, M. Bonifazi, F. Porcarelli, S. Gasparini, G. Sica, T. Valente, D. Biondini, M. Damin, V. Liani, M. Tamburrini, C. Sorino, F. Mezzasalma, M. Scaramozzino, L. Pini, M. Bezzi, G. Marchetti. - In: PULMONOLOGY. - ISSN 2531-0429. - (2022), pp. 1-7. [Epub ahead of print] [10.1016/j.pulmoe.2022.01.010]
Abstract:
Background and objectives: Diagnosis of tuberculous pleurisy (TP) may be challenging and it
often requires pleural biopsy. A tool able to increase pre-test probability of TP may be helpful to
guide diagnostic work-up and enlargement of internal mammary lymph node (IMLN) has been
suggested to play a potential role.
The aim of the present investigation was to assess role of IMLN involvement in TP in a multi-centric
case-control study, by comparing its prevalence and test performance to those observed in patients
with infectious, non-tuberculous pleurisy (NTIP), and in controls free from respiratory diseases (CP).
Methods: A total of 419 patients, from 14 Pulmonology Units across Italy were enrolled (127 patients
affected by TP, 163 affected by NTIP and 129 CP). Prevalence, accuracy and predictive values of ipsi-
lateral IMLN involvement between cases and control groups were assessed, as well as concordance
between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements.
Results: The prevalence of ipsilateral IMLN involvement in TP was significantly higher than that
observed in NTIP and CP groups (respectively 77.2%, 39.3% and 14.7%). Results on test perfor-
mance, stratified by age, revealed a high positive predictive value in patients aged 50 years,
while a high negative predictive value in patients aged >50 years. The comparison between CT
scan and ultrasound showed moderate agreement (Kappa=0.502).
Conclusions: Evaluation of IMLN involvement plays a relevant role in assessing the pre-test probability
of TP. Considering the increasing global prevalence of mycobacterial infections, a tool able to guide
diagnostic work-up of suspected TP is crucial, especially where local sources are limited.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Computed tomography; Diagnosis; Internal mammary lymph node; Pleural effusion; Thoracic ultrasound; Tuberculosis; Tuberculous pleurisy
Elenco autori:
G. Levi, C. Rocchetti, F. Mei, G. Stella, S. Lettieri, F. Lococo, F. Taccari, C. Seguiti, M. Fantoni, F. Natali, P. Candoli, C. Bortolotto, V. Pinelli, M. Mondoni, P. Carlucci, A. Fabbri, M. Trezzi, L. Vannucchi, M. Bonifazi, F. Porcarelli, S. Gasparini, G. Sica, T. Valente, D. Biondini, M. Damin, V. Liani, M. Tamburrini, C. Sorino, F. Mezzasalma, M. Scaramozzino, L. Pini, M. Bezzi, G. Marchetti
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