CT Clues Offer New Diagnostic Criteria for Chest Tumors

The results of a recent study are providing new diagnostic criteria to help clinicians diagnose mediastinal masses in children, and differentiate between a fungal infection histoplasmosis, and cancer.

Until now no one symptom, test or CT imaging exam has been able to distinguish between benign and cancerous masses, and this often resulted in unnecessary biopsies. The study was led by researchers from St. Jude Children’s Research Hospital (Memphis, TN, USA) and was published in the July 22, 2015, issue of the Journal of Pediatrics.

The researchers analyzed symptoms, Computed Tomography (CT) scans, and laboratory tests of 131 children with chest masses, and were able to diagnose cancers earlier and reduce the need for biopsies. Symptoms included fever, night sweats, weight loss, cough, chest pain, headaches, swelling of the neck, and physical discomfort. Laboratory tests included blood tests, and CT exams included evidence of enlarged lymph nodes and chest masses. The researchers found that in 104 children, the chest masses were benign.

Elisabeth Adderson, MD, the lead researcher, said, “The problem has been that there are both benign and malignant causes of mediastinal masses. Sometimes the malignant masses are rapidly progressive and life-threatening, and therefore it is important to make a prompt diagnosis. In contrast, the benign causes, principally the fungus histoplasmosis, are often self-limiting or respond to drugs. Like previous investigators, we found that there was no single clinical, laboratory or radiologic feature that was good enough by itself to distinguish malignant from benign masses. But the unique feature that we identified, not previously recognized, was that the presence of lymphopenia and of enlarged cervical lymph nodes on CT scans was more suggestive of a malignant diagnosis.”

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St. Jude Children’s Research Hospital