Studer U E, Scherz S, Scheidegger J, Kraft R, Sonntag R, Ackermann D, Zingg E J
Department of Urology, University of Berne, Switzerland.
J Urol. 1990 Aug;144(2 Pt 1):243-5. doi: 10.1016/s0022-5347(17)39422-3.
Preoperative axial computerized tomography scans in 163 patients with renal cell carcinoma were reviewed to assess the predictive value for the diagnosis of regional lymph node metastases. Computerized tomography was falsely negative in 5 patients: 2 had metastatic lymph nodes in the renal hilus adjacent to the primary tumor measuring 2 and 2.5 cm., and 3 had micrometastases in nodes of less than 1 cm. In 43 patients enlarged lymph nodes with a diameter of 1 to 2.2 cm. (median 1.4 cm.) were diagnosed on the preoperative scan and this was confirmed at nephrectomy and pathologically. In 18 of these 43 patients (42%) histological study showed metastases of the renal cell carcinoma in the enlarged lymph nodes. In the other 25 patients (58%) the enlarged nodes showed only inflammatory changes and/or follicular hyperplasia. This finding was significantly more frequent in patients with tumor involvement of the renal vein and tumor necrosis (p = 0.0044). We conclude that the sensitivity of preoperative computerized tomography is good for the detection of enlarged lymph nodes in patients with renal cell cancer (95%). However, significant lymph node enlargement frequently may be caused by inflammatory changes, especially in the presence of tumor necrosis. This radiological finding should not be misinterpreted as metastatic disease, unless it has been proved cytologically by fine needle aspiration.
回顾了163例肾细胞癌患者的术前轴向计算机断层扫描，以评估其对区域淋巴结转移诊断的预测价值。计算机断层扫描在5例患者中出现假阴性：2例在紧邻原发肿瘤的肾门处有转移淋巴结，大小分别为2 cm和2.5 cm；3例在直径小于1 cm的淋巴结中有微转移。43例患者在术前扫描中诊断出直径为1至2.2 cm（中位值1.4 cm）的肿大淋巴结，肾切除及病理检查证实了这一结果。在这43例患者中，18例（42%）组织学研究显示肿大淋巴结中有肾细胞癌转移。在其他25例患者（58%）中，肿大淋巴结仅显示炎症改变和/或滤泡增生。这一发现在肾静脉受肿瘤侵犯和肿瘤坏死的患者中更为常见（p = 0.0044）。我们得出结论，术前计算机断层扫描对检测肾细胞癌患者肿大淋巴结的敏感性良好（95%）。然而，明显的淋巴结肿大常常可能由炎症改变引起，尤其是在存在肿瘤坏死的情况下。除非通过细针穿刺进行细胞学证实，否则不应将这种影像学表现误解为转移性疾病。
