Has mediastinoscopy still a role in suspected stage I sarcoidosis?
Bibliographic record
Abstract
INTRODUCTION: Whether diagnostic mediastinoscopy is needed for confirmation of diagnosis in patients who present with clinical stage I sarcoidosis and no lung lesions on CT scan, is not known. METHODS: A retrospectively review of all mediastinoscopies performed from 1992 to 2003 at Health Sciences center, Winnipeg, Canada yielded 55 patients with hilar and mediastinal lymphadenopathy and normal lung parenchyma on thoracic computerized axial Scan. RESULTS: Out of a total of 1462 procedures, 55 patients with a presumptive diagnosis of Stage I sarcoidosis underwent mediastinoscopy. Median age at presentation was 47.4 +/- 12.8 years (range 24-77). The patients had mild symptoms of cough (30.9%), dyspnea (20.0%), chest pain (14.6%), malaise in (20.0%), erythema nodosum (3.6%) and uveitis (3.6%). Thoracic CT scan revealed bilateral hilar lymphadenopathy in 9 (16%), bilateral hilar lymphadenopathy plus right paratracheal lymphadenopathy in 35 (63%), right paratracheal lymphadenopathy in 7 (12%) and unilateral hilar lymphadenopathy in 4 (7.1%) subjects. Pathology revealed noncaseating granuloma, suggestive of sarcoidosis in 49 (89.1%), reactive lymph nodes in 5 (9.1%) and was nondiagnostic in 1 (1.8%). Only 2 out of these 6 non-sarcoid patients had bilateral hilar lymphadenopathy. Biopsy cultures were negative for fungus and mycobacterium in all patients. CONCLUSION: Clinical presentation of minimal symptoms, mediastinal lymphadenopathy (especially bilateral hilar and right paratracheal lymphadenopathy) with normal parenchyma on CT scan strongly suggests a diagnosis of sarcoidosis. In these cases, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".