Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study.

Computed tomography Diagnosis Internal mammary lymph node Pleural effusion Thoracic ultrasound Tuberculosis Tuberculous pleurisy

Journal

Pulmonology
ISSN: 2531-0437
Titre abrégé: Pulmonology
Pays: Spain
ID NLM: 101723786

Informations de publication

Date de publication:
18 Feb 2022
Historique:
received: 17 09 2021
revised: 25 01 2022
accepted: 25 01 2022
entrez: 22 2 2022
pubmed: 23 2 2022
medline: 23 2 2022
Statut: aheadofprint

Résumé

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). 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 ipsilateral IMLN involvement between cases and control groups were assessed, as well as concordance between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements. 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 performance, 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). 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.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
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 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 ipsilateral 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 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 performance, 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 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.

Identifiants

DOI: 10.1016/j.pulmoe.2022.01.010 PMID: 35190300
pubmed: 35190300
pii: S2531-0437(22)00022-8
doi: 10.1016/j.pulmoe.2022.01.010
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2022 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest None.

Auteurs

G Levi (G)

Interventional Pulmonology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy. Electronic address: guido.levi@asst-spedalicivili.it.

C Rocchetti (C)

Interventional Pulmonology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy.

F Mei (F)

Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.

G M Stella (GM)

Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy.

S Lettieri (S)

Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy.

F Lococo (F)

Thoracic Unit, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy.

F Taccari (F)

Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.

C Seguiti (C)

Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy; Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy.

M Fantoni (M)

Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy; Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy.

F Natali (F)

Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi IRCCS, Bologna, Italy.

P Candoli (P)

Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi IRCCS, Bologna, Italy.

C Bortolotto (C)

Department of Intensive Medicine, Unit of Radiology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy.

V Pinelli (V)

Pneumology Division, ASL5 Spezzino, Italy.

M Mondoni (M)

Respiratory Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy.

P Carlucci (P)

Respiratory Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy.

A Fabbri (A)

Pneumology Unit, Azienda USL Toscana Centro, Pistoia, Italy.

M Trezzi (M)

Infectious Diseases Unit, Azienda USL Toscana Centro, Pistoia, Italy.

L Vannucchi (L)

Department of Radiology, Azienda USL Toscana Centro, Pistoia, Italy.

M Bonifazi (M)

Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.

F Porcarelli (F)

Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.

S Gasparini (S)

Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.

G Sica (G)

Radiology Unit, Azienda Ospedali dei Colli, Monaldi Hospital, Napoli, Italy.

T Valente (T)

Radiology Unit, Azienda Ospedali dei Colli, Monaldi Hospital, Napoli, Italy.

D Biondini (D)

Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy.

M Damin (M)

Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy.

V Liani (V)

Pulmonology Unit, AO Friuli Occidentale, Pordenone, Italy.

M Tamburrini (M)

Pulmonology Unit, AO Friuli Occidentale, Pordenone, Italy.

C Sorino (C)

Division of Pulmonology, Sant'Anna Hospital, Como, Italy; University of Insubria, Faculty of Medicine and Surgery, Varese, Italy.

F Mezzasalma (F)

Diagnostic and Interventional Bronchoscopy Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS, Siena, Italy.

M U Scaramozzino (MU)

Complex structure Pneumology unit, Civil hospital - Regional centre of excellence for immunoallergological diseases, Locri, Italy.

L Pini (L)

Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy; Respiratory Medicine Unit, ASST Spedali Civili, Brescia, Italy.

M Bezzi (M)

Interventional Pulmonology Unit, ASST Spedali Civili, Brescia, Italy.

G P Marchetti (GP)

Pulmonology Unit, ASST Spedali Civili, Brescia, Italy.

Classifications MeSH