非小细胞肺癌中的淋巴结大小与转移浸润
Lymph node size and metastatic infiltration in non-small cell lung cancer.
作者信息
Prenzel Klaus L, Mönig Stefan P, Sinning Jan M, Baldus Stephan E, Brochhagen Hans-Georg, Schneider Paul M, Hölscher Arnulf H
机构信息
Department of Visceral and Vascular Surgery, University of Cologne, Germany.
出版信息
Chest. 2003 Feb;123(2):463-7. doi: 10.1378/chest.123.2.463.
BACKGROUND
Preoperative lymph node staging of lung cancer by CT relies on the premise that malignant lymph nodes are larger than benign ones. Lymph nodes > 1 cm in size are regarded as metastatic nodes. The surgical approach and potential application of neoadjuvant therapy regimens are dependent on this evaluation.
PATIENTS AND METHODS
In a morphometric study, hilar and mediastinal lymph nodes from 256 patients with non-small cell lung cancer (NSCLC) were analyzed. The lymph nodes were counted, the largest diameter of each lymph node was measured, and each lymph node was analyzed for metastatic involvement by histopathologic examination. The frequency of metastatic involvement was calculated and correlated with lymph node size. Preoperative CT scans of 80 patients were retrospectively analyzed by a staff radiologist. Lymph node size was measured, and lymph nodes were evaluated due to radiologic criteria. The radiologic evaluation was compared to the histopathologic diagnosis.
RESULTS
A total of 2,891 lymph nodes were present in the 256 specimens examined for this study. One hundred thirty-nine patients had a pN0 status, whereas 117 patients had lymph nodes that were positive for cancer. Two thousand four hundred eighty-six lymph nodes (86%) were tumor-free, while 405 (14%) showed metastatic involvement on histopathologic examination. The mean (+/- SD) diameter of the nonmetastatic lymph nodes was 7.05 +/- 3.75 mm, whereas infiltrated nodes had a diameter of 10.7 +/- 4.7 mm (p = 0.005). One thousand nine hundred fifty-three of the tumor-free lymph nodes (79%) and 170 of the metastatic lymph nodes (44%) were < 10 mm in diameter. Of 139 patients with no metastatic lymph node involvement, 101 (77%) had at least one lymph node that was > 10 mm in diameter. Of 127 patients with metastatic lymph node involvement, 12% had no lymph node that was < 10 mm. The independent radiologic evaluation of the CT scans of 80 patients yielded a sensitivity of 57.1% and a specificity of 80.6%.
CONCLUSION
Lymph node size is not a reliable parameter for the evaluation of metastatic involvement in patients with NSCLC.
背景
CT对肺癌进行术前淋巴结分期依赖于恶性淋巴结大于良性淋巴结这一前提。直径大于1cm的淋巴结被视为转移淋巴结。手术方式及新辅助治疗方案的潜在应用均依赖于这一评估。
患者与方法
在一项形态学研究中，分析了256例非小细胞肺癌（NSCLC）患者的肺门和纵隔淋巴结。对淋巴结进行计数，测量每个淋巴结的最大直径，并通过组织病理学检查分析每个淋巴结是否存在转移累及。计算转移累及的频率，并将其与淋巴结大小进行关联。一名放射科工作人员对80例患者的术前CT扫描进行回顾性分析。测量淋巴结大小，并根据放射学标准对淋巴结进行评估。将放射学评估结果与组织病理学诊断结果进行比较。
结果
本研究共检查了256个标本中的2891个淋巴结。139例患者为pN0状态，而117例患者的淋巴结存在癌转移。2486个淋巴结（86%）无肿瘤，而405个（14%）在组织病理学检查中显示有转移累及。无转移淋巴结的平均（±标准差）直径为(7.05\pm3.75)mm，而有浸润的淋巴结直径为(10.7\pm4.7)mm（p = 0.005）。1953个无肿瘤的淋巴结（79%）和170个转移淋巴结（44%）直径小于10mm。在139例无转移淋巴结累及的患者中，101例（77%）至少有一个直径大于10mm的淋巴结；在127例有转移淋巴结累及的患者中，12%没有直径小于10mm的淋巴结。对80例患者的CT扫描进行独立放射学评估，敏感性为57.1%，特异性为80.6%。
结论
淋巴结大小并非评估NSCLC患者转移累及的可靠参数。
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