Varadarajulu Shyam, Schmulewitz Nathan, Wildi Stephan M, Roberts Stacey, Ravenel James, Reed Carolyn E, Block Mark, Hoffman Brenda J, Hawes Robert H, Wallace Michael B
Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Gastrointest Endosc. 2004 Mar;59(3):345-8. doi: 10.1016/s0016-5107(03)02541-0.
Increasingly, EUS is being used to stage lung cancer. Direct mediastinal invasion (T4) by lung cancer is stage IIIb disease. Patients in this stage have a 5-year survival of less than 5% and generally are offered chemotherapy without surgery. This study evaluated the accuracy of EUS in detecting T4 lung cancer.
The study included all patients with lung cancer who had EUS staging and subsequent staging at surgery, or for whom there was unequivocal confirmation of unresectability (T4) by thoracoscopy, thoracotomy or presence of malignant pleural effusion, or definite invasion of great vessels/adjacent organs on CT.
A total of 175 of 308 patients with lung cancer who underwent EUS over a 5-year period (1997-2002) had subsequent confirmatory tumor staging. Ten patients were found by EUS to have stage T4 tumors; 7 were confirmed to be T4 by either surgical exploration (2), CT demonstration of aortic invasion (3), or documentation of malignant pleural effusion (2). Three of the 10 (30%) patients found to have stage T4 tumors by EUS had T2 disease at surgery and underwent curative resection. Of the remaining 165 patients without evidence of T4 disease at EUS, only one was found to have aortic invasion (T4) at surgery. EUS had a sensitivity of 87.5%, specificity of 98%, positive predictive value of 70%, and a negative predictive value of 99% for detecting T4 disease.
Caution is warranted when unresectability of lung cancer is based solely on tumor invasion into mediastinal soft tissue at EUS. Overstaging occurs when a tumor appears to invade the pleural layer without mediastinal organ invasion. Confirmation of unresectability by other diagnostic modalities is warranted in such instances.
超声内镜（EUS）越来越多地用于肺癌分期。肺癌直接侵犯纵隔（T4）属于Ⅲb期疾病。此期患者的5年生存率低于5%，通常接受化疗而非手术治疗。本研究评估了EUS检测T4期肺癌的准确性。
该研究纳入了所有接受EUS分期且随后接受手术分期的肺癌患者，或通过胸腔镜、开胸手术明确证实不可切除（T4），或存在恶性胸腔积液，或CT显示大血管/相邻器官有明确侵犯的患者。
在1997年至2002年的5年期间，308例接受EUS检查的肺癌患者中，共有175例随后进行了肿瘤分期确认。EUS检查发现10例患者为T4期肿瘤；其中7例经手术探查（2例）、CT显示主动脉侵犯（3例）或恶性胸腔积液记录（2例）证实为T4期。EUS检查发现为T4期肿瘤的10例患者中，有3例（30%）手术时为T2期疾病并接受了根治性切除。在其余165例EUS检查未发现T4期疾病证据的患者中，手术时仅1例发现主动脉侵犯（T4）。EUS检测T4期疾病的敏感性为87.5%，特异性为98%，阳性预测值为70%，阴性预测值为99%。
当仅根据EUS检查发现肿瘤侵犯纵隔软组织而判定肺癌不可切除时，需谨慎。当肿瘤似乎侵犯胸膜层而无纵隔器官侵犯时，会出现分期过度的情况。在这种情况下，有必要通过其他诊断方法来确认不可切除性。
