Okubo Kenichi, Kato Tatsuo, Hara Akira, Yoshimi Naoki, Takeda Keiichi, Iwao Fumihiko
General Thoracic SurgeryGifu National Hospital, Gifu, Japan.
Ann Thorac Surg. 2004 Oct;78(4):1190-3. doi: 10.1016/j.athoracsur.2004.04.028.
Lymph node metastasis of lung cancer has been evaluated with histologic examination. We studied the usefulness of cytologic diagnosis for detecting metastasis of lung cancer in mediastinal nodes.
Five hundred twelve stations of mediastinal nodes in 157 patients with lung cancer were excised for staging of the disease through mediastinoscopy or thoracoscopy. Among them, 474 stations of mediastinal nodes in 151 patients were examined for metastasis both with imprint cytology and with hematoxylin-eosin histology independently. The final diagnostic decision was made by overall pathologic information, including cytology and histology. The diagnostic accuracies were compared between cytologic and histologic examinations.
Cytologic examination identified 66 positive stations and 2 suspicious stations in 45 patients, whereas histologic examination identified 61 positive stations in 42 patients. The final pathologic diagnosis was 70 positive stations and 1 suspicious station in 45 patients. The sensitivity, accuracy, and negative predictive value of cytologic examination for node metastasis were 95.7%, 99.4%, and 99.3%, respectively, and those of histologic examination were 87.1%, 98.1%, and 97.7%, respectively. On a patient basis the sensitivity, accuracy, and negative predictive value of cytologic examination were 100%, 100%, and 100%, respectively, whereas those of histologic examination were 93.8%, 98.0%, and 97.2%, respectively. An additional 3 patients (2.0%) who had contralateral mediastinal node metastasis diagnosed only with cytology were identified with upstaged disease.
Imprint cytology for detecting metastasis of lung cancer in mediastinal nodes has high sensitivity and accuracy and is no less useful than histologic examination.
肺癌的淋巴结转移已通过组织学检查进行评估。我们研究了细胞学诊断在检测肺癌纵隔淋巴结转移中的作用。
对157例肺癌患者的512个纵隔淋巴结站进行切除，通过纵隔镜或胸腔镜进行疾病分期。其中，对151例患者的474个纵隔淋巴结站分别进行印片细胞学和苏木精-伊红组织学检查以检测转移情况。最终诊断决策基于包括细胞学和组织学在内的全面病理信息。比较了细胞学和组织学检查的诊断准确性。
细胞学检查在45例患者中发现66个阳性站和2个可疑站，而组织学检查在42例患者中发现61个阳性站。最终病理诊断为45例患者中有70个阳性站和1个可疑站。细胞学检查对淋巴结转移的敏感性、准确性和阴性预测值分别为95.7%、99.4%和99.3%，组织学检查的分别为87.1%、98.1%和97.7%。以患者为基础，细胞学检查的敏感性、准确性和阴性预测值分别为100%、100%和100%，而组织学检查的分别为93.8%、98.0%和97.2%。另外3例（2.0%）仅通过细胞学诊断为对侧纵隔淋巴结转移的患者被发现疾病分期上调。
用于检测肺癌纵隔淋巴结转移的印片细胞学具有高敏感性和准确性，与组织学检查同样有用。
