Noninvasive testing of asymptomatic bilateral hilar adenopathy

Journal Article · Thu Mar 01 00:00:00 EST 1990 · Journal of General Internal Medicine; (USA)

DOI:https://doi.org/10.1007/BF02600516· OSTI ID:6870649

Carr, P L; Singer, D E; Goldenheim, P; Bernardo, J; Mulley, A G ^[1]

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1. Massachusetts General Hospital, Boston (USA)

The diagnostic strategy for asymptomatic patients with persistent bilateral bilar adenopathy often involves invasive procedures. The authors used Bayesian analysis to: (1) estimate the relative prevalences of diseases causing bilateral bilar adenopathy; (2) assess changes in the prevalence of disease by race, the presence of other clinical symptoms, and geography; and (3) determine the value of relevant noninvasive tests, including the angiotensin-converting enzyme (ACE) assay, gallium scan, and purified protein derivative (PPD), in order to assess when a strategy of watchful waiting is appropriate. The analysis indicated that the ACE assay, particularly when paired with the PPD, can identify many patients who might safely be managed without immediate invasive biopsy. Patients who are ACE+ and PPD- have an estimated probability of sarcoidosis of 0.95 or greater; patients who are ACE- and PPD+ have a probability of tuberculosis of 0.86 if black, 0.79 if white. In contrast, gallium scanning has no diagnostic role in this clinical situation. Bronchoscopic or mediastinoscopic biopsy has a limited role for patients who are ACE+ PPD- or ACE- PPD+ because of limited sensitivity. Patients who are both ACE- and PPD-, particularly if white, may have a high enough risk of lymphoma to consider invasive biopsy.

• OSTI ID: 6870649
• Journal Information: Journal of General Internal Medicine; (USA), Vol. 5:2; ISSN 0884-8734
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
LUNGS
RADIOISOTOPE SCANNING
RESPIRATORY SYSTEM DISEASES
DIAGNOSIS
GALLIUM ISOTOPES
LYMPHOMAS
PATIENTS
PEPTIDE HYDROLASES
PROTEINS
SENSITIVITY ANALYSIS
SPECIFICITY
TUBERCULOSIS
BACTERIAL DISEASES
BODY
COUNTING TECHNIQUES
DISEASES
ENZYMES
HYDROLASES
IMMUNE SYSTEM DISEASES
INFECTIOUS DISEASES
ISOTOPES
NEOPLASMS
ORGANIC COMPOUNDS
ORGANS
RESPIRATORY SYSTEM
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