Chiles C
Duke University Medical Center, Durham, North Carolina.
Radiol Clin North Am. 1990 May;28(3):539-53.
Histologic examination of the lymph nodes is the only 100% accurate method of detecting metastatic disease. Even the pathologist encountering a lymph node cannot predict from the macroscopic appearance whether a lymph node is involved with tumor. Because enlarged lymph nodes may be free of tumor, and nodes of normal size may contain metastases, the accuracy of CT in the detection of hilar involvement by tumor is limited. The primary role of imaging procedures in the preoperative staging of patients with bronchogenic carcinoma is to determine the need for further prethoracotomy assessment. Decisions regarding operability of lung cancer should be based on tissue verification. Recognition of hilar abnormality requires a thorough understanding of normal bronchial and pulmonary vascular anatomy. The administration of intravenous contrast material can facilitate the distinction on a CT scan image of enhancing pulmonary vessels from nonenhancing hilar lymph nodes.
淋巴结的组织学检查是检测转移性疾病的唯一100%准确的方法。即使是病理学家遇到一个淋巴结，也无法从肉眼外观判断该淋巴结是否有肿瘤累及。因为肿大的淋巴结可能没有肿瘤，而正常大小的淋巴结可能含有转移灶，所以CT检测肿瘤肺门受累的准确性是有限的。成像检查在支气管源性癌患者术前分期中的主要作用是确定是否需要进一步的开胸术前评估。关于肺癌可切除性的决策应基于组织学验证。识别肺门异常需要对正常支气管和肺血管解剖有透彻的了解。静脉注射造影剂有助于在CT扫描图像上区分强化的肺血管和不强化的肺门淋巴结。
