Detterbeck Frank C, Jantz Michael A, Wallace Michael, Vansteenkiste Johan, Silvestri Gerard A
Division of Thoracic Surgery, Department of Surgery, Yale University, 330 Cedar St, FMB 128, New Haven, CT 06520-8062, USA.
Chest. 2007 Sep;132(3 Suppl):202S-220S. doi: 10.1378/chest.07-1362.
The treatment of non-small cell lung cancer (NSCLC) is determined by accurate definition of the stage. If there are no distant metastases, the status of the mediastinal lymph nodes is critical. Although imaging studies can provide some guidance, in many situations invasive staging is necessary. Many different complementary techniques are available.
The current guidelines and medical literature that are applicable to this issue were identified by computerized search and were evaluated using standardized methods. Recommendations were framed using the approach described by the Health and Science Policy Committee of the American College of Chest Physicians.
Performance characteristics of invasive staging interventions are defined. However, a direct comparison of these results is not warranted because the patients selected for these procedures have been different. It is crucial to define patient groups, and to define the need for an invasive test and selection of the best test based on this.
In patients with extensive mediastinal infiltration, invasive staging is not needed. In patients with discrete node enlargement, staging by CT or positron emission tomography (PET) scanning is not sufficiently accurate. The sensitivity of various techniques is similar in this setting, although the false-negative (FN) rate of needle techniques is higher than that for mediastinoscopy. In patients with a stage II or a central tumor, invasive staging of the mediastinal nodes is necessary. Mediastinoscopy is generally preferable because of the higher FN rates of needle techniques in the setting of normal-sized lymph nodes. Patients with a peripheral clinical stage I NSCLC do not usually need invasive confirmation of mediastinal nodes unless a PET scan finding is positive in the nodes. The staging of patients with left upper lobe tumors should include an assessment of the aortopulmonary window lymph nodes.
非小细胞肺癌（NSCLC）的治疗取决于准确的分期定义。如果没有远处转移，纵隔淋巴结的状况至关重要。尽管影像学检查可以提供一些指导，但在许多情况下，有创分期是必要的。有许多不同的辅助技术可供使用。
通过计算机检索确定适用于此问题的当前指南和医学文献，并使用标准化方法进行评估。建议采用美国胸科医师学会健康与科学政策委员会描述的方法制定。
定义了有创分期干预措施的性能特征。然而，由于选择进行这些程序的患者不同，因此无法对这些结果进行直接比较。确定患者群体，并基于此确定有创检查的必要性和选择最佳检查至关重要。
对于纵隔广泛浸润的患者，不需要进行有创分期。对于有孤立性淋巴结肿大的患者，CT或正电子发射断层扫描（PET）扫描分期不够准确。在这种情况下，各种技术的敏感性相似，尽管针吸技术的假阴性（FN）率高于纵隔镜检查。对于II期或中央型肿瘤患者，纵隔淋巴结的有创分期是必要的。由于在淋巴结大小正常的情况下针吸技术的FN率较高，纵隔镜检查通常更可取。外周临床I期NSCLC患者通常不需要对纵隔淋巴结进行有创确认，除非PET扫描显示淋巴结阳性。左上叶肿瘤患者的分期应包括对主动脉肺窗淋巴结的评估。
