ArticleQuantitative imaging in medicine and surgery2026
Differentiating pulmonary sarcoidosis from mediastinal lymph node metastasis via conventional computed tomography features and quantitative imaging parameters: a retrospective study.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pulmonary sarcoidosis and mediastinal lymph node metastasis (MLNM) secondary to lung cancer frequently present with overlapping imaging features on chest computed tomography (CT), posing considerable diagnostic challenges. Although histopathological confirmation remains the gold standard, noninvasive CT-based strategies may provide supplementary information to aid in pretest probability estimation. This study evaluated the ability of a multivariate diagnostic framework comprising certain conventional quantitative CT parameters to differentiate pulmonary sarcoidosis from MLNM. Methods: This retrospective, single-center study included 125 patients with histopathologically confirmed diagnoses who underwent standardized chest CT between January 2022 and December 2024, comprising 40 patients with pulmonary sarcoidosis and 85 with lung cancer involving MLNM. Three conventional CT features were measured for the single largest mediastinal lymph node per patient: short-axis diameter (mm), contrast enhancement value [in Hounsfield units (HU)], and anatomical nodal station classified according to the International Association for the Study of Lung Cancer (IASLC) lymph node station map. Baseline characteristics were compared via the independent samples Results: Significant differences were observed between the sarcoidosis and lung cancer groups in terms of age (51.16±12.85 Conclusions: Although the composite CT-based model demonstrated high specificity, the moderate sensitivity indicates that approximately one-third of malignant cases would not be correctly identified by imaging criteria alone. These CT-derived quantitative parameters are thus not a reliable substitute for histopathological confirmation. Patients with indeterminate mediastinal lymphadenopathy should be referred for tissue sampling-preferably via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-regardless of CT imaging findings. The proposed model should be considered a supplementary, hypothesis-generating research tool.
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