Imamura M, Murata T, Yoshida M, Neyatani H, Imokawa S, Shirai T, Taniguchi M, Nakazawa K, Arai T, Sato A
Department of Radiology, Fujieda Municipal Shida General Hospital.
Nihon Igaku Hoshasen Gakkai Zasshi. 1990 Sep 25;50(9):1068-81.
We investigated and compared the ability to diagnose metastasis of lung cancer to the mediastinum and hilar lymph nodes using CT and EUS (endoscopic ultrasonography by radial scanning method) in 27 patients undergoing resection of primary lung cancer and 6 autopsy cases. We also determined the relationship between the presence or absence of metastasis and the size of each lymph node based on the lymph node size measured at the time of resection and its histopathological findings, and we then set up a standard value that was the most accurate in evaluating the presence or absence of metastasis using a receiver operating characteristic (ROC) curve. When lymph node sizes appearing as images were compared with their actual sizes measured on resected specimens before formalin fixation, the short axis measured by either method was found to generally agree with the actual values, while the long axis was slightly smaller than the actual values, although EUS gave more accurate values. When the ability to diagnose metastasis was compared between CT and EUS using the standard value obtained from the ROC curve (a more than 8 mm short axis was defined as positive for metastasis), there were no differences in the ability to delineate the entire area of the mediastinum, including hilar lymph nodes. With respect to individual sites, although there was some difficulty delineating some regions in the mediastinum (pretracheal lymph node) with EUS, more lymph nodes in the mediastinum that were delineated by EUS histopathologically had metastatic lesions than those delineated by CT. However, both methods often failed to delineate hilar lymph nodes, with no difference shown between these two methods.
我们对27例接受原发性肺癌切除术的患者及6例尸检病例，使用CT和EUS（径向扫描法内镜超声检查）来研究并比较诊断肺癌转移至纵隔及肺门淋巴结的能力。我们还根据切除时测量的淋巴结大小及其组织病理学结果，确定转移的有无与各淋巴结大小之间的关系，然后使用受试者操作特征（ROC）曲线建立一个在评估转移有无方面最准确的标准值。当将图像上出现的淋巴结大小与在福尔马林固定前切除标本上测量的实际大小进行比较时，发现两种方法测量的短轴一般与实际值相符，而长轴略小于实际值，不过EUS给出的值更准确。当使用从ROC曲线获得的标准值（短轴超过8 mm定义为转移阳性）比较CT和EUS诊断转移的能力时，在勾勒包括肺门淋巴结在内的整个纵隔区域的能力方面没有差异。就各个部位而言，尽管用EUS勾勒纵隔中的某些区域（气管前淋巴结）存在一些困难，但经组织病理学证实，EUS勾勒出的纵隔中转移病变的淋巴结比CT勾勒出的更多。然而，两种方法通常都难以勾勒出肺门淋巴结，这两种方法之间没有差异。
