MEDIASTINAL LYMPHADENOPATHY: HISTORICAL EVOLUTION, DIAGNOSTIC AND TREATMENT CHALLENGES

Mediastinal lymphadenopathy (MLA) is an important clinical and radiological syndrome encountered in a wide range of diseases, including neoplastic, infectious, granulomatous, inflammatory, and reactive processes. The deep anatomical location of mediastinal lymph nodes, the similarity of radiological findings in different diseases, and the need for an accurate morphological diagnosis to select modern treatment strategies determine the clinical rele­vance of this problem. This literature review analyzes the formation and historical evolution of the concept of medi­astinal lymphadenopathy, the anatomical and radiological criteria of mediastinal lymph nodes, the capabilities and limitations of computed tomography (CT) and ^18F-FDG PET/CT, the etiological differential diagnosis of mediastinal lymphadenopathy, and the principles of treatment. The development of methods for morphological assessment of mediastinal lymph nodes is also briefly reviewed, with emphasis on the major stages in the transition toward modern minimally invasive diagnostics. In current clinical practice, endobronchial and esophageal endosonography have be­come important methods for obtaining tissue samples from mediastinal lymph nodes. According to the 2026 ERS/ESGE/ESTS clinical practice guideline, endosonography is recommended in preference to mediastinoscopy for mediastinal lymph node tissue staging.