Mediastinal granulomatous inflammation and overall survival in patients with a history of malignancy

Rationale: Investigators have postulated that mediastinal granulomatous inflammation is associated with prolonged overall survival in patients with cancer. Objectives: We sought to determine whether mediastinal granulomatous inflammation affects overall survival in patients with a history of treated cancer. Methods: Patients with a history of treated cancer who underwent endobronchial ultrasound-transbronchial needle aspiration (EBUSTBNA) for evaluation of mediastinal or hilar lymphadenopathy were grouped based on whether they had mediastinal granulomatous inflammation or benign mediastinal lymphadenopathy without granulomas.Overall survival from the date of EBUS-TBNA to cancerrelated death or to last follow-up in patient groups was compared. Measurements and Main Results: We reviewed the records of 106 patients (44 with mediastinal granulomatous inflammation and 62 with benign mediastinal lymphadenopathy). The 3-year survival rate was 90% overall and 93 and 88% in patients with mediastinal granulomatous inflammation and benign mediastinal lymphadenopathy, respectively (P = 0.40). After multivariate adjustment, whether patients had mediastinal granulomatous inflammation or benign mediastinal lymphadenopathy did not significantly affect the risk of cancer death (mediastinal granulomatous inflammation to benign mediastinal lymphadenopathy hazard ratio, 1.27; P = 0.76). Conclusions: These results suggest that patients who develop mediastinal granulomatous inflammation after cancer treatment do not have an increased overall survival when compared with patients who develop benign mediastinal lymphadenopathy. EBUS-TBNA is warranted for patientswith treated cancerwhodevelop mediastinal and/ or hilar lymphadenopathy to avoid erroneous upstaging ormisdiagnosis of cancer recurrence that would lead to suboptimal management.