Massone Pier Paolo Brega, Lequaglie Cosimo, Magnani Barbara, Ferro Franca, Cataldo Ignazio
Oncologic Thoracic Surgery (PPBM, CL, IC), Istituto Nazionale Tumori, Milan, Italy.
Ann Surg Oncol. 2003 Dec;10(10):1197-202. doi: 10.1245/aso.2003.03.538.
The aim of this study was to evaluate the impact of video-assisted thoracoscopic surgery (VATS) in the diagnosis and therapy of clinical mediastinal lymphadenopathies.
In our Institute, from 1995 to 2001, 85 patients underwent VATS biopsy: 55 subjects (group 1) for suspected lung cancer (65%) and 30 (group 2) for unknown nodes enlargement (35%). Lymphonodes were considered suspected if > 1 cm by radiological imaging. We performed 83 thoracoscopic biopsies: 33 in level 5 (39%), 24 in level 6 (29%), 19 in level 7 (22%), and 7 in level 8 (8%).
A histological analysis of frozen sections was made in every case. Twenty subjects underwent lung resection in one-time (24%). Histology in group 1 was adenocarcinoma in 28 cases, epidermoid carcinoma in 14, microcytoma in 9, and giant-cell carcinoma in 4. Ten patients were at stage I, 10 at stage II, 33 at stage III, and two at stage IV. Histology of group 2 was lymphoma in 18 cases, sarcoidosis in eight, and focal aspecific hyperplasia in four.
The usefulness of VATS allowed the pathological assessment of the presumed involved mediastinal lymph nodes in every patient and thus permitted to assure in all the cases the indicated therapeutic treatment.
本研究旨在评估电视辅助胸腔镜手术（VATS）在临床纵隔淋巴结病诊断和治疗中的作用。
1995年至2001年，我院85例患者接受了VATS活检：55例（第1组）怀疑为肺癌（65%），30例（第2组）为不明原因的淋巴结肿大（35%）。影像学检查淋巴结直径>1 cm者被视为可疑。我们共进行了83例胸腔镜活检：第5组33例（39%），第6组24例（29%），第7组19例（22%），第8组7例（8%）。
每例均进行了冰冻切片组织学分析。20例患者一次性接受了肺切除术（24%）。第1组组织学类型为腺癌28例，鳞癌14例，小细胞癌9例，巨细胞癌4例。10例患者为Ⅰ期，10例为Ⅱ期，33例为Ⅲ期，2例为Ⅳ期。第2组组织学类型为淋巴瘤18例，结节病8例，局灶性非特异性增生4例。
VATS的实用性使每位患者受累纵隔淋巴结的病理评估成为可能，从而确保在所有病例中都能进行针对性的治疗。
