Cancer Resources > Cancer News > 2004 > November

Conservative treatment recommended for mediastinal CT masses

M. Mary Conroy

Last Updated: 2004-11-29 15:55:57 -0400 (Reuters Health)

CHICAGO (Reuters Health) - Mediastinal masses appear frequently in computer-assisted tomography (CT) lung cancer screening series, but investigators conducting an on-going lung cancer screening study report that these lesions can be treated conservatively, without surgery.

The researchers presented the mediastinal masses data from the Early Lung Cancer Action Project (ELCAT) and the New York Early Lung Cancer Action Project (NY ELCAT) this weekend at the Radiological Society of North American 90th scientific assembly and annual meeting.

The researchers reviewed all of the 9286 baseline CT scans of persons enrolled in the ELCAT and NY-ELCAT as well as data from 9992 annual repeat screenings. Dr. Claudia Henschke, at the Weill Medical College of Cornell University, New York, said the screening program detected 128 mediastinal masses -- a rate of about 1.40%.

"When we discussed these findings with other physicians, there was concern that these masses should be excised," Dr. Henschke said. "However, our research suggests that mediastinal masses found in the context of CT screening for lung cancer in asymptomatic people should be approached in a 'conservative' manner, as most did not increase in size and some even decreased in size."

Of the thymic masses of less than 3 cm, 8% decreased in size when imaged a second time; 72% did not change size and 20% lesions increased in size. Five thymic lesions larger than 2 cm were excised, and one was determined to be esophageal cancer.

Patients in the screening ELCAT trials are eligible if they are at high risk of lung cancer because of long-term smoking or age.

"I think that these mediastinal lesions should be left alone, too," said Dr. Robert Tarver, of Indiana University School of Medicine, Indianapolis. Dr. Tarver moderated the oral abstract session in which Dr. Henschke presented her research.

"These are slow-growing lesions and they are probably not going to do anything bad to the patient." He added that if the lesions are "bad players," doing extensive surgery might not be very helpful anyway. He noted that one of the lesions in Dr. Henschke's study that was excised turned out to be esophageal cancer. Even if caught early, esophageal cancer has a poor long-term outcome.

Dr. Henschke said the masses included 57 lymph node growths that were at least 2 millimeters in length at the longest points; 41 thymic lesions; 16 thyroid lesions, 8 tracheal/esophageal lesions and 6 "other" lesions.

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