Potepan P, Meroni E, Spinelli P, Laffranchi A, Danesini G M, Milella M, Marchesini M, Spagnoli I
Unità Operative di Radiodiagnostica A, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano.
Radiol Med. 1999 Jan-Feb;97(1-2):42-7.
A prospective comparative study with pathology was performed at the National Cancer Institute, Milan, to assess the clinical value of Computed Tomography (CT) and endoscopic ultrasound (EUS) for nodal staging in lung cancer.
In three years, 71 patients with histological diagnosis of non-small-cell lung cancer were operated on. They underwent CT and EUS examinations to identify mediastinal lymphadenopathies after major nodal involvement had been excluded by chest X-ray. Diagnostic staging was completed in two weeks prior to treatment. Patients received complete tumor removal and radical lymphadenectomy (55 patients), invasive staging with node resection and sampling (11 patients), or mediastinoscopy (5 patients). Blinded interpretation of CT alone, EUS alone, and CT and EUS together were performed, with systematic correlation of imaging findings and pathological results.
The frequency of mediastinal involvement was 42.2%. A total of 329 nodal stations were dissected or sampled and 755 lymph nodes were examined at histology. On a per-station basis, CT had greater sensitivity (74%) than EUS (56%), but EUS was more specific (83.4% vs 92.7%). The accuracy rates of the two techniques were similar (CT 81%, EUS 83%). A site by site analysis showed highest sensitivity (100%) in the lower right paratracheal nodes for CT, and in the superior left paratracheal and subcarinal nodes for EUS. When the EUS and CT images were studied together by specialists on a per-station basis, sensitivity, specificity, and accuracy increased to 85%.
Endoscopic ultrasound should be part of the routine preoperative diagnostic approach to non-small-cell lung cancer, because of its high specificity. Results can be improved when EUS and CT are combined, which suggests that these imaging modalities should be used together in selected patients for the noninvasive staging of non-small-cell lung cancer to identify local lymphatic spread.
在米兰国家癌症研究所进行了一项与病理学相关的前瞻性对比研究，以评估计算机断层扫描（CT）和内镜超声（EUS）在肺癌淋巴结分期中的临床价值。
三年内，对71例经组织学诊断为非小细胞肺癌的患者进行了手术。在胸部X线排除主要淋巴结受累后，他们接受了CT和EUS检查以识别纵隔淋巴结肿大。在治疗前两周完成诊断分期。患者接受了完整的肿瘤切除和根治性淋巴结清扫术（55例）、有创分期并进行淋巴结切除和取样（11例）或纵隔镜检查（5例）。对单独的CT、单独的EUS以及CT和EUS联合进行了盲法解读，并将影像学结果与病理结果进行了系统关联。
纵隔受累的频率为42.2%。总共解剖或取样了329个淋巴结站，并对755个淋巴结进行了组织学检查。在每个淋巴结站的基础上，CT的敏感性（74%）高于EUS（56%），但EUS更具特异性（分别为83.4%和92.7%）。两种技术的准确率相似（CT为81%，EUS为83%）。逐个部位分析显示，CT对右下气管旁淋巴结的敏感性最高（100%），EUS对左上气管旁和隆突下淋巴结的敏感性最高。当专家在每个淋巴结站的基础上一起研究EUS和CT图像时，敏感性、特异性和准确率提高到了85%。
由于内镜超声具有高特异性，应将其作为非小细胞肺癌术前常规诊断方法的一部分。当EUS和CT联合使用时结果可以得到改善，这表明在选择的患者中应将这些影像学方法一起用于非小细胞肺癌的无创分期，以识别局部淋巴转移。
