Medical University of South Carolina, Charleston, SC.
Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada.
Chest. 2013 May;143(5 Suppl):e211S-e250S. doi: 10.1378/chest.12-2355.
Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making.
Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables.
The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections.
Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive needle techniques to stage the mediastinum have become increasingly accepted and are the tests of first choice to confirm mediastinal disease in accessible lymph node stations. If negative, these needle techniques should be followed by surgical biopsy. All abnormal scans should be confirmed by tissue biopsy (by whatever method is available) to ensure accurate staging. Evidence suggests that more complete staging improves patient outcomes.
正确分期肺癌很重要，因为治疗选择和预后在不同分期有显著差异。有多种非侵入性影像学研究和有创性检查可供选择。了解用于分期非小细胞肺癌的现有方法的准确性、优点和缺点，对于决策至关重要。
从美国胸科医师学会肺癌指南的第二次迭代更新了可用分期研究的测试准确性。系统地在 MEDLINE 数据库中进行了搜索，截止日期为 2012 年 6 月，并包括了一些荟萃分析、实践指南和综述。研究设计和结果总结在证据表中。
CT 扫描用于识别纵隔淋巴结转移的敏感性和特异性分别约为 55%和 81%，证实 CT 扫描在排除或确定纵隔转移方面的能力有限。对于 PET 扫描，用于识别纵隔转移的敏感性和特异性的估计值分别约为 77%和 86%。这些发现表明 PET 扫描比 CT 扫描更准确，但仍需要进行组织活检来确认 PET 扫描结果。针技术，包括支气管内超声引导下针吸活检、内镜超声引导下针吸活检和支气管内超声/内镜超声引导下针吸活检，其敏感性分别约为 89%、89%和 91%。与外科分期相比，针技术已成为获得组织的最佳初始诊断工具。基于随机对照试验，推荐使用 PET 或 PET-CT 扫描进行分期，并检测未发现的转移性疾病，以避免非治愈性切除。
自分期指南的最后一次迭代以来，PET 扫描在术前和评估转移性疾病方面都发挥了更重要的作用。用于分期纵隔的微创针技术越来越被接受，并且是确认可触及淋巴结站纵隔疾病的首选测试。如果为阴性，这些针技术应随后进行外科活检。所有异常扫描都应通过组织活检（无论采用何种方法）确认，以确保准确分期。有证据表明，更完整的分期可改善患者的预后。
