Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
J Thorac Oncol. 2010 Mar;5(3):389-98. doi: 10.1097/JTO.0b013e3181ce3e5e.
BACKGROUND: Many clinicians use restaging after induction therapy as a way to select patients for surgery. METHODS: A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery. RESULTS: A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging. CONCLUSION: The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.
背景：许多临床医生在诱导治疗后进行再分期，以此选择适合手术的患者。
方法：系统评价旨在确定诱导治疗后 III（N2）期肺癌患者再分期检查与手术病理结果的一致性。
结果：所有部位完全缓解的 CT 和正电子发射断层扫描假阴性（FN）率分别为 50%和 30%。CT 显示纵隔淋巴结受累的 FN 和假阳性率分别为 33%和 33%，而正电子发射断层扫描的 FN 和假阳性率分别为 25%和 33%。重复纵隔镜检查的 FN 率为 22%，专家操作下的食管超声和针吸检查为 14%（支气管内超声尚未提供可靠结果），而最佳全面性的原发性纵隔镜检查为 9%。这些结果不受诱导治疗类型或再分期时间的影响。
结论：除了仔细的原发性纵隔镜检查外，其他方法识别纵隔降期的能力较差。
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