Cerfolio Robert James, Bryant Ayesha S, Eloubeidi Mohamad A
Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd, THT 712, Birmingham, AL 35294, USA.
Chest. 2006 Dec;130(6):1791-5. doi: 10.1378/chest.130.6.1791.
Despite normal mediastinal (N2) lymph nodes shown on positron emission tomography (PET) and CT, some physicians routinely perform mediastinoscopy and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA) in patients with non-small cell lung cancer (NSCLC).
A prospective trial on patients with NSCLC who were clinically staged N2 negative by both integrated PET/CT and CT scan. All underwent mediastinoscopy and EUS-FNA and if N2 negative underwent thoracotomy with thoracic lymphadenectomy.
There were 153 patients (107 men). Of these, 136 patients were clinically staged N0 and 17 patients were clinically staged N1. Of the 136 patients who were staged as N0, 5 patients (3.7%) had positive EUS-FNA results (three in the subcarinal node), and 4 patients (2.9%) had positive mediastinoscopy results (all in the #4R node; one was N3). Six of the remaining 127 patients (4.7%) had N2 disease after resection. Seventeen patients were clinically staged as N1 by integrated PET/CT. Four patients (23.5%) had positive EUS-FNA results (two in the subcarinal node), 3 patients (17.6%) had positive mediastinoscopy results (all in #4R node; two were N2 and one was N3), and none of the remaining 10 patients had N2 disease after resection. Patients with unsuspected N2 disease were twice as likely (relative risk, 2.1; 95% confidence interval, 1.24 to 2.51; p = 0.02) to have a maximum standardized uptake value (maxSUV) > 10 and poorly differentiated cancer (relative risk, 2.1; 95% confidence interval, 1.14 to 2.38; p = 0.03).
We do not recommend routine mediastinoscopy or EUS-FNA in patients who are clinically staged as N0 after both integrated PET/CT and CT. However, these procedures should both be considered in patients clinically staged as N1 after PET/CT, and/or in those with adenocarcinoma, upper-lobe tumors, or tumors with a maxSUV > or = 10.
尽管正电子发射断层扫描（PET）和计算机断层扫描（CT）显示纵隔（N2）淋巴结正常，但一些医生仍常规对非小细胞肺癌（NSCLC）患者进行纵隔镜检查和/或超声内镜细针穿刺活检（EUS-FNA）。
对经PET/CT和CT扫描临床分期为N2阴性的NSCLC患者进行一项前瞻性试验。所有患者均接受纵隔镜检查和EUS-FNA，若N2阴性则行开胸手术及胸段淋巴结清扫术。
共有153例患者（107例男性）。其中，136例患者临床分期为N0，17例患者临床分期为N1。在136例分期为N0的患者中，5例（3.7%）EUS-FNA结果为阳性（3例在隆突下淋巴结），4例（2.9%）纵隔镜检查结果为阳性（均在#4R淋巴结；1例为N3）。其余127例患者中有6例（4.7%）术后出现N2期疾病。17例患者经PET/CT临床分期为N1。4例（23.5%）EUS-FNA结果为阳性（2例在隆突下淋巴结），3例（17.6%）纵隔镜检查结果为阳性（均在#4R淋巴结；2例为N2，1例为N3），其余10例患者术后均未出现N2期疾病。未被怀疑有N2期疾病的患者出现最大标准化摄取值（maxSUV）>10和低分化癌的可能性是其他患者的两倍（相对风险，2.1；95%置信区间，1.24至2.51；p = 0.02）。
对于经PET/CT和CT临床分期为N0的患者，我们不建议常规进行纵隔镜检查或EUS-FNA。然而，对于PET/CT临床分期为N1的患者，和/或腺癌、上叶肿瘤或maxSUV≥10的肿瘤患者，应考虑进行这两种检查。
