Ghent University Hospital, Department of Respiratory Medicine and Thoracic Oncology, Ghent, Belgium.
Lancet Oncol. 2012 May;13(5):e221-9. doi: 10.1016/S1470-2045(11)70407-7.
Clinical TNM staging is the standard method used to decide treatment for patients with non-small-cell lung cancer. Although integrated fluorodeoxyglucose (FDG) PET CT increases the accuracy of staging, it only guides direct tissue sampling. Histological assessment of mediastinal lymph nodes has traditionally been done with mediastinoscopy, a surgical procedure. Endobronchial and oesophageal ultrasound-guided lymph node sampling have been assessed as additions or alternatives to mediastinoscopy. We review endosonography and surgical staging, and show that both have a place in the mediastinal staging of lung cancer. We conclude that mediastinal tissue staging should preferentially start with a complete endosonographic assessment. A surgical mediastinoscopy should be reserved for those in whom the endosonography result is negative. Further refinement of this recommendation is likely in the near future because data suggest that the confirmatory mediastinoscopy is particularly useful for patients with enlarged or FDG-avid lymph nodes.
临床 TNM 分期是用于决定非小细胞肺癌患者治疗方案的标准方法。尽管整合氟脱氧葡萄糖（FDG）PET CT 提高了分期的准确性，但它只能指导直接组织取样。纵隔淋巴结的组织学评估传统上采用纵隔镜检查，这是一种外科手术。经支气管和食管超声引导下的淋巴结取样已被评估为纵隔镜检查的补充或替代方法。我们回顾了超声内镜和外科分期，并表明两者在肺癌纵隔分期中都有一席之地。我们得出结论，纵隔组织分期应优先进行完整的超声内镜评估。对于超声内镜结果为阴性的患者，应保留外科纵隔镜检查。由于数据表明，对于纵隔淋巴结肿大或 FDG 摄取活跃的患者，确认性纵隔镜检查特别有用，因此这种建议可能在不久的将来进一步细化。
