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Thoracic Imaging |
1 From the Weill Medical College of Cornell Univ, 525 E 68th St, New York, NY 10021 (C.I.H., A.F., D.Y., N.K.A.); Medical College of Hallym Univ, Seoul, Korea (I.J.L.); Cancer Hosp, Chinese Academy of Medical Sciences, Beijing, China (N.W.); and North Shore–Long Island Jewish Health System, New Hyde Park, NY (A.K.). Received Feb 15, 2005; revision requested Apr 12; revision received May 2; accepted June 3; final version accepted July 5. ELCAP supported in part by NIH grant R01-CA-63393, Eastman-Kodak, General Electric, and the National Cancer Institute. NYELCAP supported by the City of New York Dept of Health and Mental Hygiene; Starr Foundation; Empire Blue Cross and Blue Shield; New York Community Trust; New York State Office of Science, Technology, and Academic Research; the Rogers Family Fund; Weill Medical College of Cornell Univ; Cornell Univ; and AMDeC Foundation. Members of the ELCAP and NYELCAP study groups are listed in the Acknowledgments. Address correspondence to C.I.H. (e-mail: chensch{at}med.cornell.edu).
Purpose: To determine the frequency and natural course of mediastinal masses in asymptomatic people at high risk for lung cancer who were undergoing computed tomographic (CT) screening.
Materials and Methods: Informed consent and institutional review board approval for this HIPAA-compliant study were obtained at each participating institution. All documented mediastinal masses among the 9263 baseline and 11 126 annual repeat screenings performed in the Early Lung Cancer Action Project (ELCAP) and its successor project, the New York ELCAP, were identified. Two radiologists confirmed all cases, identified the location and measured the diameter (average of length and width) of each mass, and reviewed all subsequent CT and clinical and surgical results. The prevalence and incidence of mediastinal masses were then determined.
Results: Of the 9263 individuals, 71 had a mediastinal mass seen at baseline screening (prevalence of 0.77%). Of the 71 masses, 41 were thymic, 16 were thyroidal, two were esophageal cancers, six were tracheal-esophageal diverticula, and six were other masses. Among the 11 126 annual repeat screenings, only one new mediastinal mass was identified (incidence of 0.01%). This suggests a long average duration for mediastinal masses in asymptomatic people. Among the 41 thymic masses, five were larger than 3.0 cm in diameter, and all five were resected; of these five, one was a thymic carcinoma and four were noninvasive thymomas. Of the remaining 36 thymic masses, 25 were evaluated at follow-up CT 1 year later: Five had increased in diameter, two had decreased, and 18 remained unchanged. All 16 thyroid masses were due to goiter; none of these were changed at follow-up CT 1 year later.
Conclusion: Mediastinal masses found in the context of CT screening for lung cancer in asymptomatic people should be approached in a "conservative" manner; this includes thymic masses smaller than 3 cm in diameter, as most of these remain unchanged or even decrease in size.
© RSNA, 2006
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