van Overhagen Hans, Brakel Koen, Heijenbrok Mark W, van Kasteren Jan H L M, van de Moosdijk Cees N F, Roldaan Albert C, van Gils Ad P, Hansen Bettina E
Department of Radiology, Leyenburg Hospital, Leyweg 245, 2545 CH The Hague, the Netherlands.
Radiology. 2004 Jul;232(1):75-80. doi: 10.1148/radiol.2321030663. Epub 2004 May 27.
To compare ultrasonography (US), computed tomography (CT), and palpation for diagnosing supraclavicular lung cancer metastases and to assess the effect of proved metastases on TNM stage and diagnostic work-up.
One hundred seventeen consecutive patients (91 men and 26 women; mean age, 64.0 years) underwent palpation, US, and CT of supraclavicular regions and chest and upper abdominal CT. Fine-needle aspiration cytologic (FNAC) analysis was performed in patients with nodes with a short-axis diameter of 5 mm or greater; cytologic diagnosis was used as the standard of reference. Sensitivities of palpation, US, and CT were compared with McNemar testing. Relationship between size and palpability of nodes with metastasis was evaluated with logistic regression.
Supraclavicular metastases were diagnosed cytologically in 30 (26%) of 117 patients: eight (31%) of 26 patients with small cell lung cancer (SCLC) and 22 (24%) of 91 patients with non-small cell lung cancer (NSCLC). Sensitivities of US (1.00; 30 of 30 patients) and CT (0.83; 25 of 30 patients) for detection of metastases were significantly higher (P <.001 and P =.001, respectively) than that of palpation (0.33; 10 of 30 patients). Palpable nodes with metastasis (mean diameter, 25.2 mm) were significantly larger than nonpalpable nodes with metastasis (mean diameter, 13.7 mm) (P =.002). To have a 50% chance of being palpable, nodes with metastasis had to have a diameter of at least 22.3 mm. TNM stage was changed in three of 91 patients with NSCLC, and further invasive diagnostic procedures were prevented in 11 of such patients because it was proved that nonpalpable nodes had metastases.
Supraclavicular lung cancer metastases were cytologically proved in 26% of patients. Nodes with metastasis were only palpable when markedly enlarged. US tripled the sensitivity of palpation for detection of metastases. Results of US and US-guided FNAC analysis can change the work-up in patients with lung cancer.
比较超声检查（US）、计算机断层扫描（CT）和触诊在诊断锁骨上肺癌转移方面的效果，并评估已证实的转移对TNM分期和诊断检查的影响。
连续117例患者（91例男性，26例女性；平均年龄64.0岁）接受了锁骨上区域、胸部及上腹部的触诊、超声检查和CT检查。对短轴直径≥5mm的淋巴结患者进行细针穿刺细胞学（FNAC）分析；细胞学诊断作为参考标准。采用McNemar检验比较触诊、超声检查和CT的敏感性。通过逻辑回归评估转移淋巴结大小与可触知性之间的关系。
117例患者中，30例（26%）经细胞学诊断为锁骨上转移：26例小细胞肺癌（SCLC）患者中有8例（31%），91例非小细胞肺癌（NSCLC）患者中有22例（24%）转移。超声检查（1.00；30例患者中的30例）和CT检查（0.83；30例患者中的25例）检测转移的敏感性显著高于触诊（0.33；30例患者中的10例）（P分别<.001和P =.001）。有转移的可触及淋巴结（平均直径25.2mm）明显大于有转移的不可触及淋巴结（平均直径13.7mm）（P =.002）。为了有50%的可触及几率，有转移的淋巴结直径必须至少达到22.3mm。91例NSCLC患者中有3例TNM分期发生改变，11例此类患者因证实不可触及的淋巴结有转移而避免了进一步的侵入性诊断程序。
26%的患者经细胞学证实有锁骨上肺癌转移。有转移的淋巴结只有在明显肿大时才可触及。超声检查检测转移的敏感性是触诊的三倍。超声检查及超声引导下FNAC分析结果可改变肺癌患者的诊断检查。
