Diagnostic Value of Radiographic Characteristics of Mediastinal and Hilar Lymph Nodes in Sarcoidosis

OBJECTIVE: In this study, it was aimed to investigate the diagnostic value of thorax computed tomography, which is a non-invasive method, in diagnosing sarcoidosis. MATERIALS AND METHODS: In our Faculty of Medicine, Department of Chest Diseases between January 1, 2013, and July 1, 2019, the data of 816 patients who underwent endobronchial ultrasonography for mediastinal lymph node sampling and other sampling methods, such as mediastinoscopy, thoracotomy, etc., if the histopathological diagnosis could not be reached, were retrospectively screened and 192 patients (sarcoidosis: 62, non-sarcoidosis: 130 patients) who met the inclusion criteria were included in the study. Patients diagnosed with sarcoidosis and patients diagnosed with non-sarcoidosis were compared in terms of thorax computed tomography findings (mediastinal lymph nodes and lung parenchymal involvement). RESULTS: Right upper paratracheal (72.6 vs. 46.9%, P = .001) and paraaortic lymph node involvement (79.0% vs. 60.8%, P = .01), hilar symmetry (88.5 vs. 58.3%, P < .001), and homogeneity in lymph nodes (80.6% vs. 56.9%, P = .001) were found to be significantly higher in the sarcoidosis group. Lymph node sizes were smaller in the sarcoidosis group and the mean density (51.3 Hounsfield unit vs. 44.1 Hounsfield unit, P = .002) was significantly higher. In the multivariate logistic regression analysis, the presence of homogeneity in the lymph nodes is 4.3-fold more likely to increase sarcoidosis, the presence of hilar symmetry 9.1-fold, the involvement of the right lower paratracheal lymph node 2.7-fold, the mean lymphadenopathy density >48 Hounsfield unit 4.3-fold, the maximum diameter of lymphadenopathy less than 27.5 mm 4.7-fold. CONCLUSION: This study revealed that the localization, size, density, and homogeneity of mediastinal lymph nodes will help clinicians to diagnose patients with sarcoidosis without using invasive methods.