Sparup J, Friis M, Brenøe J, Vejlsted H, Villumsen B, Olesen K P, Borgeskov S, Bertelsen S
Department of Thoracic and Vascular Surgery, Bispebjerg Hospital, Copenhagen, Denmark.
Scand J Thorac Cardiovasc Surg. 1990;24(3):207-11. doi: 10.3109/14017439009098071.
Computed tomography (CT) of the thorax and upper abdomen was prospectively evaluated in 84 patients with potentially operable lung cancer. Invasion into the thoracic wall and the mediastinal structures was not accurately demonstrated by CT. For metastatic mediastinal lymph nodes, the sensitivity and specificity of CT were, respectively, 86% and 61% and the positive and negative predictive indices 49% and 91%. For T1, T2 and T3 tumours the negative indices were 100%, 96% and 71%. Positive predictive index did not differ between squamous cell carcinoma and adenocarcinoma. Adrenal metastases were CT-suspected in 17 cases and liver metastases in eight, but were verified by ultrasonography in only one and four cases. CT should be used in preoperative investigation of lung cancer, irrespective of stage. Demonstration of thoracic-wall or mediastinal invasion need not exclude tumour resection. Preoperative mediastinoscopy is indicated if CT shows nodal metastases or if there are signs of tumour invasion, but not in CT-negative T1 or T2 tumour. Abdominal metastases indicated by CT should be investigated with CT-guided needle biopsy.
对84例可能可手术切除的肺癌患者的胸部和上腹部计算机断层扫描（CT）进行了前瞻性评估。CT不能准确显示对胸壁和纵隔结构的侵犯情况。对于纵隔转移淋巴结，CT的敏感性和特异性分别为86%和61%，阳性和阴性预测指数分别为49%和91%。对于T1、T2和T3肿瘤，阴性指数分别为100%、96%和71%。鳞状细胞癌和腺癌的阳性预测指数没有差异。CT怀疑有17例肾上腺转移和8例肝转移，但超声仅证实1例肾上腺转移和4例肝转移。无论肺癌处于何阶段，CT均应用于术前检查。胸壁或纵隔侵犯的显示并不一定排除肿瘤切除。如果CT显示有淋巴结转移或有肿瘤侵犯迹象，则需进行术前纵隔镜检查，但CT检查阴性的T1或T2肿瘤则无需进行。CT提示的腹部转移应通过CT引导下针吸活检进行检查。
