Ohno Kiyoshi, Utsumi Tomoki, Sasaki Yoshiaki, Suzuki Yuko
Department of Surgery, Osaka Kosei-Nenkin Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka, 553-0003, Japan.
Eur J Cardiothorac Surg. 2004 Apr;25(4):492-6. doi: 10.1016/j.ejcts.2003.12.035.
The purpose of this study was to determine the most suitable candidates for scalene lymph node biopsy to detect non-palpable scalene lymph node metastasis (N(3)-scalene) in non-small cell lung cancer patients.
Standard cervical mediastioscopies and ipsilateral scalene lymph node biopsies were performed preoperatively by a single surgeon on 121 consecutive patients with non-small cell lung cancer scheduled to have surgical resection between January 1997 and August 2002, who had neither evidence of distant metastasis on imaging diagnosis nor palpable supraclavicular lymph nodes.
N(3)-scalene was detected in six patients (5.0%), who all had non-squamous cell carcinoma, including one (1.0%) out of 98 patients with negative standard cervical mediastinoscopy and five (21.7%) out of the remaining 23 patients with positive mediastinal lymph node involvement. There was a significant difference in the incidence of the N(3)-scalene between the two groups (P<0.01). Five patients with N(3)-scalene had metastatic lesions in the multilevel mediastinal lymph node station on the same side as the cancer (multilevel N(2)), and accounted for 31.3% of 16 patients with multilevel N(2) disease. The N(3)-scalene was detected in 5 (45.5%) of 11 patients with lung cancer classified as non-squamous cell carcinoma with multilevel N(2) disease.
The results of the present study suggest that non-palpable scalene lymph node biopsy is indicated for lung cancer patients diagnosed as having non-squamous cell carcinoma with mediastinoscopic multilevel N(2) disease.
本研究旨在确定非小细胞肺癌患者中，进行斜角肌淋巴结活检以检测不可触及的斜角肌淋巴结转移（N(3)-斜角肌）的最合适人选。
1997年1月至2002年8月期间，由一名外科医生对121例计划接受手术切除的非小细胞肺癌患者术前进行标准颈部纵隔镜检查和同侧斜角肌淋巴结活检，这些患者在影像学诊断中均无远处转移证据且无可触及的锁骨上淋巴结。
6例患者（5.0%）检测到N(3)-斜角肌转移，均为非鳞状细胞癌，其中98例标准颈部纵隔镜检查阴性的患者中有1例（1.0%），其余23例纵隔淋巴结受累阳性的患者中有5例（21.7%）。两组间N(3)-斜角肌转移发生率有显著差异（P<0.01）。5例N(3)-斜角肌转移患者在与癌症同侧的多级纵隔淋巴结站有转移灶（多级N(2)），占16例多级N(2)疾病患者的31.3%。在11例被归类为非鳞状细胞癌且有多级N(2)疾病的肺癌患者中，有5例（45.5%）检测到N(3)-斜角肌转移。
本研究结果表明，对于诊断为非鳞状细胞癌且纵隔镜检查为多级N(2)疾病的肺癌患者，建议进行不可触及的斜角肌淋巴结活检。
