De Leyn Paul, Lardinois Didier, Van Schil Paul E, Rami-Porta Ramon, Passlick Bernward, Zielinski Marcin, Waller David A, Lerut Tony, Weder Walter
Eur J Cardiothorac Surg. 2007 Jul;32(1):1-8. doi: 10.1016/j.ejcts.2007.01.075. Epub 2007 Apr 19.
Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC) is of paramount importance. It will guide choices of treatment and determine prognosis and outcome. Over the last years, different techniques have become available. They vary in accuracy and procedure-related morbidity. The Council of the ESTS initiated a workshop on preoperative mediastinal lymph node staging. This resulted in guidelines for primary staging and restaging. For primary staging, mediastinoscopy remains the gold standard for the superior mediastinal lymph nodes. Invasive procedures can be omitted in patients with peripheral tumors and negative mediastinal positron emission tomography (PET) images. However, in case of central tumors, PET hilar N1 disease, low fluorodeoxyglucose uptake of the primary tumor and LNs > or = 16 mm on CT scan, invasive staging remains indicated. PET positive mediastinal findings should always be cyto-histologically confirmed. Transbronchial needle aspiration (TBNA), ultrasound-guided bronchoscopy with fine needle aspiration (EBUS-FNA) and endoscopic esophageal ultrasound-guided fine needle aspiration (EUS-FNA) are new techniques that provide cyto-histological diagnosis and are minimally invasive. Their specificity is high but the negative predictive value is low. Because of this, if they yield negative results, an invasive surgical technique is indicated. However, if fine needle aspiration is positive, this result may be valid as proof for N2 or N3 disease. For restaging, invasive techniques providing cyto-histological information are advisable despite the encouraging results supported with the use of PET/CT imaging. Both endoscopic techniques and surgical procedures are available. If they yield a positive result, non-surgical treatment is indicated in most patients.
准确对非小细胞肺癌（NSCLC）患者进行纵隔淋巴结术前分期及再分期至关重要。它将指导治疗方案的选择并决定预后和结局。在过去几年中，出现了不同的技术。它们在准确性和与操作相关的发病率方面存在差异。欧洲胸外科医师协会（ESTS）理事会发起了一次关于术前纵隔淋巴结分期的研讨会。这产生了原发性分期和再分期的指南。对于原发性分期，纵隔镜检查仍然是上纵隔淋巴结的金标准。对于周围型肿瘤且纵隔正电子发射断层扫描（PET）图像为阴性的患者，可以省略侵入性操作。然而，对于中央型肿瘤、PET显示肺门N1疾病、原发性肿瘤氟脱氧葡萄糖摄取低且CT扫描显示淋巴结≥16mm的情况，仍需进行侵入性分期。PET显示纵隔阳性结果应始终通过细胞组织学确诊。经支气管针吸活检（TBNA）、超声引导支气管镜下细针穿刺活检（EBUS-FNA）和内镜超声引导下细针穿刺活检（EUS-FNA）是提供细胞组织学诊断且微创的新技术。它们的特异性高，但阴性预测值低。因此，如果它们得出阴性结果，则需采用侵入性手术技术。然而，如果细针穿刺活检结果为阳性，该结果可能作为N2或N3疾病的有效证据。对于再分期，尽管PET/CT成像取得了令人鼓舞的结果，但提供细胞组织学信息的侵入性技术仍是可取的。内镜技术和手术方法都可行。如果它们得出阳性结果，大多数患者需进行非手术治疗。
