Sensitivity and Specificity of Mediastinoscopy Our assumption of 100% sensitivity and specificity of mediastinoscopy favors the procedure. Mikhail et al reported a sensitivity of 88% for mediastinoscopy in patients with BHL in whom a diagnosis of sarcoidosis was thought likely. Lack of specificity is encountered in that small percentage of patients with systemic noncaseating granuloma […]

Estimate Precision We have been unable to find a case report of an AD presenting as ABHL, and compendia of the clinical and radiographic features of TB and lymphoma contain no examples. Estimates of the proportion of ADs that present as ABHLs were derived in each instance by assuming a value high in the range […]

Forty-three of the 65 (66%) surveyed pulmonologists responded. Of these, 30 (70%) favored observation over invasive procedures; of those favoring an invasive procedure, 6 recommended transbronchial lung biopsy, and 2, mediastinoscopy. The remaining five respondents favored an invasive procedure or observation depending on particulars. Thus, about one third of respondents advocated an invasive procedure under […]

Sarcoidosis: Patients receive reassurance that the radiographic abnormality is not neoplastic in origin and the security of a verified diagnosis. Tuberculosis: Primary TB is most often self-limited; progressive pulmonary disease or extension to the cervical lymphatics will evolve in fewer than 5%; miliary disease and meningitis are less frequent sequelae in adults than children. TB […]

Non-Hodgkin s Lymphoma: Low-grade NHLs, which constitute 40% of cases, are widely disseminated and incurable in 90% of patients. Prognosis in patients with intermediate and high-grade (aggressive) NHL (60%) is correlated with early stage at diagnosis, age younger than 60 years, high performance status, and normal lactate dehydrogenase values, and is curable in half. In […]

Unspecified Lymphoma: Among 100 consecutive cases of lymphoma reported from the Mayo Clinic, 9 had BHL; how often it was an isolated finding was not stated. All were “ill of serious progressive disease and all had obvious extrathoracic disease, most often palpable lymph nodes. Of 212 patients with lymphomas described by Winterbauer et al, only […]

We conducted a mail survey of 65 pulmonologists who were members of the Oregon Thoracic Society practicing in Oregon and southwest Washington to ascertain their practice preferences— observation, mediastinoscopy, transbronehial lung biopsy, or other—in patients with BHLps. Results Characteristics and Frequencies of ABHL Sarcoidosis: The estimated US incidence of clinically identified sarcoidosis (ie, identified either […]

Risk and Benefit Estimates: Risk estimates for mediastinoscopy and benefits of earlier diagnosis of AD were derived from a literature survey. Cost Estimates: Comprehensive charges for mediastinoscopy and transbronehial biopsy, inclusive of sample processing, were provided by the fee schedule department, Kaiser Permanente, Northwest Region, which are market rates based on 50 to 80% of […]

A Risk/Benefit, Cost/Benefit Analysis There is disagreement about the need for tissue confirmation in patients with a presumptive diagnosis of stage 1 sarcoidosis (SIS) when bilateral hilar adenopathy (BHL) is accompanied by erythema nodosum, uveitis, polyarthralgia or trivial chest symptoms, or when symptoms are lacking. Winter-bauer et al, in the seminal quantitative investigation of this […]