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Wentao Fang



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    MS03 - Workup and Management of Small Anterior Mediastinal Masses/Lesions (ID 66)

    • Event: WCLC 2019
    • Type: Mini Symposium
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
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      MS03.04 - Followup/Surveillance of Small Anterior Mediastinal Lesions (Now Available) (ID 3452)

      13:30 - 15:00  |  Presenting Author(s): Wentao Fang

      • Abstract
      • Presentation
      • Slides

      Abstract

      With increasing popularity of CT screening for early stage lung cancers, there is a tendency toward increased detection of small anterior mediastinal nodules. However, work-up and management strategy for such incidentally found small mediastinal lesions remains to be established.

      During 2013-2018, 415 patients with incidentally found small anterior mediastinal mass less than 3 cm in diameter were retrieved from a prospectively kept database at the Division of Mediastinal Surgery, Shanghai Chest Hospital. A marked increase was seen in the annual number of such cases detected (Figure 1). MRI was used in addition to CT scan for differential diagnosis in 413 cases. The other 2 patients could not receive MRI because of metal implantation at previous surgery.

      Eight-nine patients received surgery, 82 (92.1%) of them turned out to have thymic epithelial tumors (Table). Among thymic tumor patients, 36 had a follow-up history for a median of 18 months, and 27 (75%) of the lesions increased in size. Thymic carcinomas and neuroendocrine tumors enlarged more rapidly than type B2/B3 thymomas, and the latter more rapidly than type A/AB/B1 tumors (Figure 2). Two of the seven thymic carcinomas were upstaged to UICC T3 lesions, and nodal involvement was found in two thymic carcinoma and one atypical carcinoid patients. The other 33 tumors were all in UICC stage Ia. Seven patients turned out to have bronchogenic cysts (3) or thymic cysts (4). None of them had follow-up history and 5 of them received surgery because of MR suspected thymomas. Thus the accuracy of MRI for diagnosing thymic tumors was 94.1% (80/85).

      Three-hundred-twenty-six patients are still under follow-up, 311 of them were diagnosed of having benign lesions (cysts, hyperplasia, lymph nodes) by MRI. With a median follow-up of 33 months, none but one MRI diagnosed cyst increased by 0.3 cm after 3 years. Two MRI diagnosed cystic and two hyperplasic lesions decreased in size during follow-up. Thirteen patients with MRI diagnosed clinical stage I thymomas refused surgery. Only two of the lesions increased in size by 0.2-0.3 cm after 2 years (Table).

      In conclusion, MRI is highly useful in differential diagnosis of small anterior mediastinal lesions. Follow-up could be safely recommended for those MRI diagnosed benign lesions.

      Table. Change in size during follow-up for small anterior mediastinal lesions.

      Diagnosis

      Patient

      Size

      Follow-up

      Size (+)

      Size (-)

      (Number)

      (Mean, cm)

      (Median, month)

      (Number)

      (Number)

      Surgery (TET)

      36

      2.4

      18

      27

      0

      AB

      11

      2.4

      36

      2

      0

      B

      11

      2.5

      12

      4

      0

      Ca

      7

      2.3

      24

      6

      0

      NETT

      3

      2.3

      15

      3

      0

      Metaplastic

      2

      1.1

      36

      2

      0

      Micronodular

      2

      2.1

      5

      0

      0

      No-surgery

      326

      2.2

      33

      3

      4

      TET

      13

      1.5

      18

      2

      0

      Cyst

      267

      2.3

      36

      1

      2

      LN

      24

      1.2

      24

      0

      0

      Hyperplasia

      22

      2.4

      24

      0

      2

      Figure 1. Increasing incidence of incidentally detected small anterior mediastinal lesions at Shanghai Chest Hospital.

      figure 1.png

      Figure 2. Trends of increase in size during follow-up in different subtypes of thymic epithelial tumors.

      figure 2.png

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