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

2022; Elsevier BV; Volume: 30; Issue: 4 Linguagem: Inglês

10.1016/j.pulmoe.2022.01.010

2531-0437

Guido Levi, Chiara Rocchetti, Federico Mei, Giulia Maria Stella, Sara Lettieri, Filippo Lococo, Francesco Taccari, Cristina Seguiti, Massimo Fantoni, Filippo Natali, Piero Candoli, Chandra Bortolotto, V Pinelli, Michele Mondoni, Paolo Carlucci, Andrea Fabbri, Michele Trezzi, L Vannucchi, Martina Bonifazi, Francesco Porcarelli, Stefano Gasparini, Giacomo Sica, Tullio Valente, Davide Biondini, Marco Damin, V. Liani, Mario Tamburrini, Claudio Sorino, Fabrizio Mezzasalma, Marco Umberto Scaramozzino, Laura Pini, Michela Bezzi, Giampietro Marchetti,

Pericarditis and Cardiac Tamponade

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.