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Sarcoid-Like Reaction in Breast Cancers: A Single Center Experience

Husam Bader  , Olaedo Abana, Rama Maghnam , Husam Farraj  and Rabih Bechara 

Introduction: Sarcoidosis is a common, often multi systemic idiopathic chronic inflammatory disease diagnosed histologically by findings of epithelioid non caseating granulomas. While Fluorodeoxyglucose FDG-avid lymph nodes on Positron Emission Tomography (PET) scan in a patient with histologically confirmed malignancy should raise suspicion for nodal metastases, sarcoidosis is a known cause of benign Fluorodeoxyglucose FDG-avidity in cancer patients and must be ruled out to avoid unjustified treatment and potential toxicities. Methods: A single-center retrospective study involving 46 female patients with breast cancer was conducted. Patients included in the study had been found to have new FDG-avid mediastinal and hilar lymphadenopathy on Positron Emission Tomography (PET) scan and had undergone Endobronchial ultrasound (EBUS) / Endoscopic ultrasound (EUS) with TBNA (Trans-Bronchial Needle Aspiration). Results: Of the 46 patients in the study, 31 patients (67.4%) were found to have lymph node metastases, noncaseating granulomas consistent with sarcoid-like reactions were found in 3 patients (6.5%), and negative exam (neither sarcoid-like reactions nor nodal metastases) was found in 12 patients (26.10%). Conclusion: Pathological examination of hyper metabolic nodes must be carried out in cancer patients with PET scan findings concerning for lymph node metastases to prevent misdiagnosis and overtreatment.