Li Zhen-xuan, Yang Hong, She Ke-lin, Zhang Ming-xing, Xie Han-qing, Lin Peng, Zhang Lan-jun, Li Xiao-dong
State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, 651 Dongfeng Rd, East, Guangzhou, PR China.
J Cardiothorac Surg. 2013 Dec 8;8:225. doi: 10.1186/1749-8090-8-225.
Segmental nodes are not examined routinely in current clinical practice for lung cancer, the role of segmental nodes in pathological staging of non-small cell lung cancer after radical resection was investigated.
A total of 113 consecutive non-small cell lung cancer patients who underwent radical resection between June 2009 and December 2011 were retrospectively reviewed. All the operations were performed by the same group of surgeons. N2 nodes, hilar nodes, interlobar nodes and some lobar nodes were collected during surgery. The removed lung lobes were dissected routinely along lobar and segmental bronchi to collect lobar nodes and segmental nodes. The collected lymph nodes were separately labeled for histological examination.
The detection rates of hilar nodes, interlobar nodes, lobar nodes and segmental nodes were 61.1%, 85.0%, 75.2% and 80.5%, respectively. The metastasis rates of hilar nodes, interlobar nodes, lobar nodes and segmental nodes were 5.3%, 10.5%, 16.8% and 14.2%, respectively. There were 68 cases of N0 disease, 16 cases of N1 disease and 29 cases of N2 disease. If an analysis of segmental lymph nodes had been omitted, six patients (37.5% of N1 disease) would have been down-staged to N0, and two cases of multiple-zone N1 disease would have been misdiagnosed as single-zone N1 disease, one patient would have been misdiagnosed as N2 disease with skip metastases.
Segmental nodes play an important role in the accurate staging of non-small cell lung cancer, and routinely dissecting the segmental bronchi to collect the lymph nodes is feasible and may be necessary.
在目前的临床实践中，肺癌患者的肺段淋巴结通常不进行常规检查，本研究旨在探讨肺段淋巴结在非小细胞肺癌根治性切除术后病理分期中的作用。
回顾性分析2009年6月至2011年12月期间连续113例行根治性切除术的非小细胞肺癌患者。所有手术均由同一组外科医生完成。手术中收集N2淋巴结、肺门淋巴结、叶间淋巴结和部分肺叶淋巴结。切除的肺叶沿叶支气管和段支气管常规解剖，以收集叶淋巴结和段淋巴结。收集的淋巴结分别标记后进行组织学检查。
肺门淋巴结、叶间淋巴结、叶淋巴结和段淋巴结的检出率分别为61.1%、85.0%、75.2%和80.5%。肺门淋巴结、叶间淋巴结、叶淋巴结和段淋巴结的转移率分别为5.3%、10.5%、16.8%和14.2%。N0期68例，N1期16例，N2期29例。如果省略对段淋巴结的分析，6例患者（占N1期的37.5%）将被降期为N0，2例多区域N1期患者将被误诊为单区域N1期，1例患者将被误诊为有跳跃转移的N2期。
肺段淋巴结在非小细胞肺癌的准确分期中起重要作用，常规解剖段支气管以收集淋巴结是可行的，且可能是必要的。
